Basic Information
| Provider Information | |||||||||
| NPI: | 1841782190 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAEFF | ||||||||
| FirstName: | ALBRA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | LLMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 29750 HARPER AVE | ||||||||
| Address2: | |||||||||
| City: | SAINT CLAIR SHORES | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480822607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867773200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 29750 HARPER AVE | ||||||||
| Address2: | |||||||||
| City: | SAINT CLAIR SHORES | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480822607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867773200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2018 | ||||||||
| LastUpdateDate: | 04/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 156F00000X | N | Eye and Vision Services Providers | Technician/Technologist | 1041C0700X | 6851114649 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.