Provider Demographics
NPI:1063440568
Name:BEACH, PATRICIA F (LMSW, ACSW, BCD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:F
Last Name:BEACH
Suffix:
Gender:F
Credentials:LMSW, ACSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25797 ARCADIA DR
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-2444
Mailing Address - Country:US
Mailing Address - Phone:248-213-0501
Mailing Address - Fax:248-213-0521
Practice Address - Street 1:29201 TELEGRAPH RD
Practice Address - Street 2:SUITE 550
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1331
Practice Address - Country:US
Practice Address - Phone:248-213-0501
Practice Address - Fax:248-213-0521
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010140151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI359631OtherMHN
MI4449385OtherAETNA INS CO
MI11543639OtherCAQH
MI253315OtherCOMP PSYCH
MI359631OtherMHN