Provider Demographics
NPI:1134131279
Name:COLLARINI, LYNN DEYELL (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:DEYELL
Last Name:COLLARINI
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 1:4835 SPLIT RAIL DR
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-7517
Mailing Address - Country:US
Mailing Address - Phone:248-426-9900
Mailing Address - Fax:248-426-9950
Practice Address - Street 1:40000 GRAND RIVER AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2121
Practice Address - Country:US
Practice Address - Phone:248-426-9900
Practice Address - Fax:248-426-9950
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010131141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical