Provider Demographics
NPI:1346458445
Name:MICHAELS, MARY ANNA (MSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANNA
Last Name:MICHAELS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:ANNA
Other - Last Name:MEIU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:1996 BROADSTONE RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1953
Mailing Address - Country:US
Mailing Address - Phone:313-530-9965
Mailing Address - Fax:
Practice Address - Street 1:36250 DEQUINDRE RD
Practice Address - Street 2:SUITE 310
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-7143
Practice Address - Country:US
Practice Address - Phone:586-795-0569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801011346104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker