Provider Demographics
NPI:1023406907
Name:MCNAMARA, LAURIE EVAN (BSW)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:EVAN
Last Name:MCNAMARA
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:EVAN
Other - Last Name:RABE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:156 S FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1354
Mailing Address - Country:US
Mailing Address - Phone:313-231-7401
Mailing Address - Fax:
Practice Address - Street 1:22170 W 9 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-6007
Practice Address - Country:US
Practice Address - Phone:248-372-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-31
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL5561791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical