Provider Demographics
NPI:1083925259
Name:MARRY, VANESSA LEIGH (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:LEIGH
Last Name:MARRY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4343 CONCOURSE DR STE 150
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-8672
Mailing Address - Country:US
Mailing Address - Phone:734-531-9947
Mailing Address - Fax:
Practice Address - Street 1:4343 CONCOURSE DR STE 150
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-8672
Practice Address - Country:US
Practice Address - Phone:734-531-9947
Practice Address - Fax:734-551-9750
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801091863104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker