Provider Demographics
NPI:1326062126
Name:RICH, MARY BETH (LMSW, DCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:BETH
Last Name:RICH
Suffix:
Gender:F
Credentials:LMSW, DCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24524 KINGS POINTE
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2714
Mailing Address - Country:US
Mailing Address - Phone:248-348-5349
Mailing Address - Fax:248-348-5349
Practice Address - Street 1:24524 KINGS POINTE
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2714
Practice Address - Country:US
Practice Address - Phone:248-348-5349
Practice Address - Fax:248-348-5349
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIM68010185571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical