Provider Demographics
NPI:1043281702
Name:GAMACHE, JOAN M (LMSW)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:M
Last Name:GAMACHE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8752 LYMAN RD
Mailing Address - Street 2:
Mailing Address - City:KALEVA
Mailing Address - State:MI
Mailing Address - Zip Code:49645-9717
Mailing Address - Country:US
Mailing Address - Phone:231-889-5664
Mailing Address - Fax:
Practice Address - Street 1:6051 FRANKFORT HWY
Practice Address - Street 2:SUITE 800
Practice Address - City:BENZONIA
Practice Address - State:MI
Practice Address - Zip Code:49616-9558
Practice Address - Country:US
Practice Address - Phone:231-882-2190
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801079085101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801079085OtherSTATE LICENSE NUMBER
MIJG079085Other3RD PARTY IDENTIFIER
MIE16035024Medicare ID - Type UnspecifiedLMSW