Provider Demographics
NPI:1467486001
Name:MARITIM-BROOKS, ANGELA RENEE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:RENEE
Last Name:MARITIM-BROOKS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:RENEE
Other - Last Name:MARITIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18600 FLORENCE ST STE T7
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4862
Mailing Address - Country:US
Mailing Address - Phone:586-552-4811
Mailing Address - Fax:586-552-4822
Practice Address - Street 1:18600 FLORENCE ST STE T7
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066
Practice Address - Country:US
Practice Address - Phone:586-552-4811
Practice Address - Fax:586-552-4822
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010724071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical