Provider Demographics
NPI:1548306624
Name:GARRISI, MICHAEL (LMSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:GARRISI
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 ANITA AVE
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1416
Mailing Address - Country:US
Mailing Address - Phone:586-222-3047
Mailing Address - Fax:586-226-8470
Practice Address - Street 1:18577 CANAL RD.
Practice Address - Street 2:SUITE 3
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038
Practice Address - Country:US
Practice Address - Phone:586-266-8440
Practice Address - Fax:586-226-8470
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1548306624OtherNPI NUMBER