Provider Demographics
NPI:1942409826
Name:DURBIN MATRONE, COLEEN (LMSW ACSW RYT)
Entity Type:Individual
Prefix:
First Name:COLEEN
Middle Name:
Last Name:DURBIN MATRONE
Suffix:
Gender:F
Credentials:LMSW ACSW RYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14998 CLEVELAND ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-8992
Mailing Address - Country:US
Mailing Address - Phone:616-842-0264
Mailing Address - Fax:616-842-3161
Practice Address - Street 1:14998 CLEVELAND ST
Practice Address - Street 2:SUITE G
Practice Address - City:SPRING LAKE
Practice Address - State:MI
Practice Address - Zip Code:49456-8992
Practice Address - Country:US
Practice Address - Phone:616-842-0264
Practice Address - Fax:616-842-3161
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010585891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical