Basic Information
Provider Information
NPI: 1720463003
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALIBRI
FirstName: JOELLE
MiddleName:  
NamePrefix: MS.
NameSuffix:  
Credential: LLMSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 175 N GROESBECK HWY
Address2:  
City: MOUNT CLEMENS
State: MI
PostalCode: 480431562
CountryCode: US
TelephoneNumber: 5866270024
FaxNumber: 5866270027
Practice Location
Address1: 175 N GROESBECK HWY
Address2:  
City: MOUNT CLEMENS
State: MI
PostalCode: 480431562
CountryCode: US
TelephoneNumber: 5866270024
FaxNumber: 5866270027
Other Information
ProviderEnumerationDate: 07/28/2015
LastUpdateDate: 02/08/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
104100000X6801097432MIY Behavioral Health & Social Service ProvidersSocial Worker 

No ID Information.


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