Provider Demographics
NPI:1467966721
Name:SANIYAH, MYRA (LLMSW)
Entity Type:Individual
Prefix:
First Name:MYRA
Middle Name:
Last Name:SANIYAH
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 1:1217 MILLER AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-3754
Mailing Address - Country:US
Mailing Address - Phone:734-635-8580
Mailing Address - Fax:
Practice Address - Street 1:122 S MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-1925
Practice Address - Country:US
Practice Address - Phone:734-945-6210
Practice Address - Fax:734-368-9115
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-24
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI69011008291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical