Healthcare Provider Details

I. General information

NPI: 1639198500
Provider Name (Legal Business Name): MARY BETH PAULINE-MORAND MSW, LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY BETH PAULINE MSW

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15370 LEVAN RD SUITE 2
LIVONIA MI
48154-1903
US

IV. Provider business mailing address

9071 BEATRICE ST
LIVONIA MI
48150-4003
US

V. Phone/Fax

Practice location:
  • Phone: 734-744-0170
  • Fax: 734-744-0171
Mailing address:
  • Phone: 734-427-3208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801072412
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: