Healthcare Provider Details

I. General information

NPI: 1689082042
Provider Name (Legal Business Name): WILLIAM L. MALETTE MSW/CADL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2014
Last Update Date: 07/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12124 W LAKE SHORE DRIVE
BRIMLEY MI
49715
US

IV. Provider business mailing address

12124 W LAKE SHORE DRIVE
BRIMLEY MI
49715
US

V. Phone/Fax

Practice location:
  • Phone: 906-248-8322
  • Fax: 906-248-5765
Mailing address:
  • Phone: 906-248-8322
  • Fax: 906-248-5765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801088530
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: