Provider Demographics
NPI:1235760448
Name:SAN JUAN, MARIA DANICA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:DANICA
Last Name:SAN JUAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2224 WOODVIEW DR APT 329
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-6808
Mailing Address - Country:US
Mailing Address - Phone:517-234-3482
Mailing Address - Fax:
Practice Address - Street 1:2224 WOODVIEW DR APT 329
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-6808
Practice Address - Country:US
Practice Address - Phone:517-234-3482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011063661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical