Basic Information
| Provider Information | |||||||||
| NPI: | 1376012237 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NICOLOSI | ||||||||
| FirstName: | KARA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 41700 GARDENBROOK RD STE 110 | ||||||||
| Address2: | |||||||||
| City: | NOVI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483751320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5862046417 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6773 W MAPLE RD | ||||||||
| Address2: | |||||||||
| City: | WEST BLOOMFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483223013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006536568 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2018 | ||||||||
| LastUpdateDate: | 08/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801108656 | MI | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 104100000X | 6801108656 | MI | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.