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NPI Code Detail

MEDICARE: PATRICIA JOANNE CORNELL LMSW, CAADC, QMRP

MEDICARE: PATRICIA JOANNE CORNELL LMSW, CAADC, QMRP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker6801090471MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1932294931
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRICIA JOANNE CORNELL LMSW, CAADC, QMRP
Provider Business Mailing Address
First Line : PO BOX 10
Second Line :
City : MASON
State : MI
Zip : 48854-0010
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5270 NORTHLAND DR NE STE B
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49525-1073
Country : US
Telephone Number : 616-344-4785
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2006
Last Update Date : 10/03/2024

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