Provider Demographics
NPI:1689082042
Name:MALETTE, WILLIAM L (MSW/CADL)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:L
Last Name:MALETTE
Suffix:
Gender:M
Credentials:MSW/CADL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12124 W LAKE SHORE DRIVE
Mailing Address - Street 2:
Mailing Address - City:BRIMLEY
Mailing Address - State:MI
Mailing Address - Zip Code:49715
Mailing Address - Country:US
Mailing Address - Phone:906-248-8322
Mailing Address - Fax:906-248-5765
Practice Address - Street 1:12124 W LAKE SHORE DRIVE
Practice Address - Street 2:
Practice Address - City:BRIMLEY
Practice Address - State:MI
Practice Address - Zip Code:49715
Practice Address - Country:US
Practice Address - Phone:906-248-8322
Practice Address - Fax:906-248-5765
Is Sole Proprietor?:No
Enumeration Date:2014-07-30
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
6801088530104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker