Provider Demographics
NPI:1932544426
Name:DUFRESNE, CATHERINE LYNN (LMSW)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:LYNN
Last Name:DUFRESNE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:LYNN
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2647 PORTOBELLO DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-2479
Mailing Address - Country:US
Mailing Address - Phone:248-854-3915
Mailing Address - Fax:
Practice Address - Street 1:2300 HAGGERTY RD STE 260
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-2184
Practice Address - Country:US
Practice Address - Phone:248-858-2457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-09
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
MI68010693631041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical