Organization
BIRMINGHAM MAPLE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LORI KANAT EDELSON LMSW (BUSINESS OWNER)
(248) 646-6659
Entity
Organization
Contact information
Practice address
2075 W BIG BEAVER RD, SUITE 520, TROY, MI 48084-3407
(248) 646-6659
(248) 642-8645
Mailing address
2075 W BIG BEAVER RD, SUITE 520, TROY, MI 48084-3407
(248) 646-6659
(248) 642-8645
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Enumeration date
01/05/2011
Last updated
04/18/2013
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