Provider Demographics
NPI:1083754873
Name:MITICH BELTZMAN, MARY ANNE (MSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANNE
Last Name:MITICH BELTZMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:ANNE
Other - Last Name:BELTZMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2755 CARPENTER RD
Mailing Address - Street 2:SUITE 3W
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1186
Mailing Address - Country:US
Mailing Address - Phone:734-476-1283
Mailing Address - Fax:
Practice Address - Street 1:2755 CARPENTER RD
Practice Address - Street 2:SUITE 3W
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1186
Practice Address - Country:US
Practice Address - Phone:734-476-1283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2016-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010128531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical