Basic Information
| Provider Information | |||||||||
| NPI: | 1871523621 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | URBAN | ||||||||
| FirstName: | GERALD | ||||||||
| MiddleName: | EDWIN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4224 FIELDBROOK RD | ||||||||
| Address2: | |||||||||
| City: | WEST BLOOMFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483233206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2489325886 | ||||||||
| FaxNumber: | 2489325886 | ||||||||
| Practice Location | |||||||||
| Address1: | 29201 TELEGRAPH RD | ||||||||
| Address2: | SUITE 550 | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480341331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482130501 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801013340 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.