Provider Demographics
NPI:1073653721
Name:MERRITT, MARTHA ANN (MSW)
Entity Type:Individual
Prefix:MISS
First Name:MARTHA
Middle Name:ANN
Last Name:MERRITT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10900 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48213
Mailing Address - Country:US
Mailing Address - Phone:313-579-5989
Mailing Address - Fax:313-579-5942
Practice Address - Street 1:19855 W OUTER DR
Practice Address - Street 2:STE 104
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124
Practice Address - Country:US
Practice Address - Phone:313-274-5840
Practice Address - Fax:313-274-8277
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010036031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical