Provider Demographics
NPI:1275868077
Name:DATI, LINDA MARIW (LMSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:MARIW
Last Name:DATI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:MARIE
Other - Last Name:DATI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:38370 MAPLE FOREST BLVD E
Mailing Address - Street 2:
Mailing Address - City:HARRISON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48045-2213
Mailing Address - Country:US
Mailing Address - Phone:586-466-5956
Mailing Address - Fax:
Practice Address - Street 1:4112 OUTLOOK BLVD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1667
Practice Address - Country:US
Practice Address - Phone:586-466-5956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-12
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010463451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical