Provider Demographics
NPI:1972771533
Name:SKORUPA, TRINA COLETTE (MSW, LMSW, PSYP, LLP)
Entity Type:Individual
Prefix:MS
First Name:TRINA
Middle Name:COLETTE
Last Name:SKORUPA
Suffix:
Gender:F
Credentials:MSW, LMSW, PSYP, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29321 HERBERT ST
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-2510
Mailing Address - Country:US
Mailing Address - Phone:248-635-9867
Mailing Address - Fax:734-425-4771
Practice Address - Street 1:8623 N WAYNE RD
Practice Address - Street 2:SUITE 310
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-1137
Practice Address - Country:US
Practice Address - Phone:734-425-0636
Practice Address - Fax:734-425-4771
Is Sole Proprietor?:No
Enumeration Date:2008-02-18
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801060926104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker