Provider Demographics
NPI:1558485482
Name:PATCHETT, BEVERLY JANE (LMSW)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:JANE
Last Name:PATCHETT
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 1:310 W HUDSON AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-3120
Mailing Address - Country:US
Mailing Address - Phone:248-336-2133
Mailing Address - Fax:248-583-9414
Practice Address - Street 1:310 W HUDSON AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-3120
Practice Address - Country:US
Practice Address - Phone:248-336-2133
Practice Address - Fax:248-583-9414
Is Sole Proprietor?:No
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010774281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI499134OtherPROVIDER
MI499134OtherPROVIDER