Provider Demographics
NPI:1548453863
Name:MISCHEL, EDWARD F (LMSW)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:F
Last Name:MISCHEL
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 1:3011 W GRAND BLVD
Mailing Address - Street 2:STE 2000
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3096
Mailing Address - Country:US
Mailing Address - Phone:800-972-4283
Mailing Address - Fax:
Practice Address - Street 1:3901 CHRYSLER DR TOLAN PARK
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-3096
Practice Address - Country:US
Practice Address - Phone:313-993-3964
Practice Address - Fax:313-993-3974
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801015691104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker