Provider Demographics
NPI:1477585511
Name:MATHIEU-DENDRINOS, JEANNE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:
Last Name:MATHIEU-DENDRINOS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:JEANNE
Other - Middle Name:
Other - Last Name:DENDRINOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:28000 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-2468
Mailing Address - Country:US
Mailing Address - Phone:586-753-0405
Mailing Address - Fax:586-753-0404
Practice Address - Street 1:17250 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3151
Practice Address - Country:US
Practice Address - Phone:734-425-4070
Practice Address - Fax:734-425-8350
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010098081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIS06260Medicare UPIN
MIQ26426089Medicare ID - Type Unspecified