Provider Demographics
NPI:1710050679
Name:BIONDO, PETRINA GRACE (MSW)
Entity Type:Individual
Prefix:
First Name:PETRINA
Middle Name:GRACE
Last Name:BIONDO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2472 EMPIRE DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324-1733
Mailing Address - Country:US
Mailing Address - Phone:248-481-9209
Mailing Address - Fax:248-481-9208
Practice Address - Street 1:2472 EMPIRE DR
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48324-1733
Practice Address - Country:US
Practice Address - Phone:248-481-9209
Practice Address - Fax:248-481-9208
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010466211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical