Basic Information
| Provider Information | |||||||||
| NPI: | 1821325283 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KERWIN | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MA, LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 452 COLONIAL CT | ||||||||
| Address2: | |||||||||
| City: | GROSSE POINTE FARMS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482362853 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3134013048 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8623 N WAYNE RD | ||||||||
| Address2: | |||||||||
| City: | WESTLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481851137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344250636 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2009 | ||||||||
| LastUpdateDate: | 03/23/2010 | ||||||||
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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 | 103TC1900X | 6301013960 | MI | Y | Behavioral Health & Social Service Providers | Psychologist | Counseling | 103T00000X | 6301013960 | MI | N | Behavioral Health & Social Service Providers | Psychologist | 103TF0000X | 6301013960 | MI | N | Behavioral Health & Social Service Providers | Psychologist | Family |
No ID Information.