Healthcare Provider Details

I. General information

NPI: 1033388442
Provider Name (Legal Business Name): DIANE MARIE DART-BADEN MA MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1547 SOUTH WAYNE ROAD
WESTLAND MI
48186
US

IV. Provider business mailing address

1547 SOUTH WAYNE ROAD
WESTLAND MI
48186
US

V. Phone/Fax

Practice location:
  • Phone: 734-729-3133
  • Fax: 734-729-3130
Mailing address:
  • Phone: 734-729-3133
  • Fax: 734-729-3130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301005874
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: