Provider Demographics
NPI:1366456600
Name:DRYGALSKI, MARYA JOSEFA (MSW, CEAP)
Entity Type:Individual
Prefix:MS
First Name:MARYA
Middle Name:JOSEFA
Last Name:DRYGALSKI
Suffix:
Gender:F
Credentials:MSW, CEAP
Other - Prefix:MS
Other - First Name:MARYA
Other - Middle Name:JOSEFA
Other - Last Name:IGNARZAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:116 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-5674
Mailing Address - Country:US
Mailing Address - Phone:586-465-4444
Mailing Address - Fax:586-783-2761
Practice Address - Street 1:24401 CAPITAL BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-1343
Practice Address - Country:US
Practice Address - Phone:586-783-2940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010602151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI139863SWOtherCARE CHOICES HMO
MI094859000OtherMAGELLAN HEALTH SERVICES
MIMD060215OtherBLUE CROSS BLUE SHIELD
MI0892947OtherBLUE CROSS BLUE SHIELD MI
MI0892947OtherBLUE CROSS BLUE SHIELD MI