Provider Demographics
NPI:1093061343
Name:MAING, JATERA (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JATERA
Middle Name:
Last Name:MAING
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2385 S HURON PKWY STE 2N
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-5127
Mailing Address - Country:US
Mailing Address - Phone:734-386-0560
Mailing Address - Fax:734-882-2861
Practice Address - Street 1:2385 S HURON PKWY STE 2N
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-5127
Practice Address - Country:US
Practice Address - Phone:734-386-0560
Practice Address - Fax:734-882-2861
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010935251041C0700X
247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical