Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 6802057967 | MI |
NPI | 1003057472 |
---|---|
Provider Name | Ms. Lorraine Mathes |
First Address | Dearborn, MI 48124 |
Second Address | Auburn Hills, MI 48326 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2009 |
Last Update Date | 16/03/2009 |