Provider Demographics
NPI:1265856587
Name:PETRIDES, MARIA (LLMSW)
Entity Type:Individual
Prefix:MISS
First Name:MARIA
Middle Name:
Last Name:PETRIDES
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37799 PROFESSIONAL CENTER DRIVE
Mailing Address - Street 2:STE 106
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-1123
Mailing Address - Country:US
Mailing Address - Phone:248-343-4695
Mailing Address - Fax:248-380-7227
Practice Address - Street 1:37799 PROFESSIONAL CENTER #106
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-1123
Practice Address - Country:US
Practice Address - Phone:248-343-4695
Practice Address - Fax:248-380-7227
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801096158104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker