Doctor Name: | LYNNE MARIE DEGRANDE |
NPI Number: | 1497758742 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSW |
License Number: | 6891911187 |
Business Practice Address: | 25480 Little Mack Ave St Clair Shores, MI - 480812157 |
Business Phone Number: | 5867776800 |
Business Fax Number: | 5867777636 |
Mailing Address: | 25480 Little Mack Ave, ST CLAIR SHORES |
State: | MI |
Postal Code: | 480812157 |
Phone Number: | 5867776800 |
Fax Number: | 5867777636 |
NPI Enumeration Date: | 05/31/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 6891911187 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |