Provider Demographics
NPI:1922526870
Name:PATIN, MADELINE GRACE (LMSW)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:GRACE
Last Name:PATIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MADELINE
Other - Middle Name:GRACE
Other - Last Name:VIERGUTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33505 SCHOOLCRAFT RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-1503
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:33505 SCHOOLCRAFT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-1503
Practice Address - Country:US
Practice Address - Phone:734-560-0687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801114336104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker