Basic Information
| Provider Information | |||||||||
| NPI: | 1750756763 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PETRICCA | ||||||||
| FirstName: | JOSEPH | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2010 HOGBACK RD STE 6G | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481058800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7343860041 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2010 HOGBACK RD STE 6G | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481058800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7343860041 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2015 | ||||||||
| LastUpdateDate: | 10/13/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801091898 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.