Provider Demographics
NPI:1093153892
Name:BRANCHEAU, MARIE C
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:C
Last Name:BRANCHEAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:C
Other - Last Name:SPERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8245 FORREST DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-4205
Mailing Address - Country:US
Mailing Address - Phone:313-570-4954
Mailing Address - Fax:
Practice Address - Street 1:100 RIVER PLACE DR STE 250
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-5402
Practice Address - Country:US
Practice Address - Phone:313-871-2337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802085010104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker