Provider Demographics
NPI:1992539134
Name:DIRETTE, MADELEINE KAY (BS, QMHP)
Entity type:Individual
Prefix:
First Name:MADELEINE
Middle Name:KAY
Last Name:DIRETTE
Suffix:
Gender:F
Credentials:BS, QMHP
Other - Prefix:
Other - First Name:MADDY
Other - Middle Name:KAY
Other - Last Name:DIRETTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS, QMHP
Mailing Address - Street 1:5340 HOLIDAY TER STE 9
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-2196
Mailing Address - Country:US
Mailing Address - Phone:269-615-9559
Mailing Address - Fax:269-381-4457
Practice Address - Street 1:5340 HOLIDAY TER STE 9
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-2196
Practice Address - Country:US
Practice Address - Phone:269-615-9559
Practice Address - Fax:269-381-4457
Is Sole Proprietor?:No
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator