Provider Demographics
NPI:1093077158
Name:MENOZZI, MARIA AMELIA (LMFT, CAADC)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:AMELIA
Last Name:MENOZZI
Suffix:
Gender:F
Credentials:LMFT, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23409 JEFFERSON AVE STE 100B
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-3449
Mailing Address - Country:US
Mailing Address - Phone:586-777-3132
Mailing Address - Fax:248-633-8829
Practice Address - Street 1:23409 JEFFERSON AVE STE 100B
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-3449
Practice Address - Country:US
Practice Address - Phone:586-777-3132
Practice Address - Fax:248-633-8829
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIC-02929101YA0400X
MI4101006595106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty