Provider Demographics
NPI:1619099264
Name:BLEEDA-VINEYARD, PATRICIA ANN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANN
Last Name:BLEEDA-VINEYARD
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 1:672 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-5020
Mailing Address - Country:US
Mailing Address - Phone:734-285-0344
Mailing Address - Fax:
Practice Address - Street 1:1600 PORTER ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48216-1936
Practice Address - Country:US
Practice Address - Phone:313-963-6601
Practice Address - Fax:313-963-6851
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010630431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical