Provider Demographics
NPI:1588751408
Name:ESSENMACHER, PATRICIA PEYTON (LMSW)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:PEYTON
Last Name:ESSENMACHER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 N LEROY ST STE A
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-2789
Mailing Address - Country:US
Mailing Address - Phone:810-347-2289
Mailing Address - Fax:810-213-0144
Practice Address - Street 1:1122 N LEROY ST STE A
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-2789
Practice Address - Country:US
Practice Address - Phone:810-347-2289
Practice Address - Fax:810-213-0144
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801019347104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI2559002Medicare PIN
MIOMO7840Medicare PIN