Provider Demographics
NPI:1215254446
Name:BAYNE, ANNETTE BOOK (LMSW)
Entity type:Individual
Prefix:MS
First Name:ANNETTE
Middle Name:BOOK
Last Name:BAYNE
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 1:388 N 3RD AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:FRUITPORT
Mailing Address - State:MI
Mailing Address - Zip Code:49415-9785
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:388 N 3RD AVE
Practice Address - Street 2:SUITE F
Practice Address - City:FRUITPORT
Practice Address - State:MI
Practice Address - Zip Code:49415-9785
Practice Address - Country:US
Practice Address - Phone:231-571-0082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-28
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010644621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical