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General NPI Number Information
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NPI Number | 1619099264
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Entity Type | Individual
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Provider Name | PATRICIA ANN BLEEDA-VINEYARD LMSW
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Gender | Female
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 09/13/2022
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Provider Practice Location Address
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Address Line | 1600 PORTER ST
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City | DETROIT
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State | MI
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Zip | 48216-1936
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Country | US
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Telephone | 313-963-6601
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Fax | 313-963-6851
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Provider Business Mailing Address
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Address Line | 672 CHESTNUT ST
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City | WYANDOTTE
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State | MI
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Zip | 48192-5020
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Country | US
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Telephone | 734-285-0344
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801063043
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License Number State | MI
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