Provider Demographics
NPI:1518410505
Name:BARTKOWIAK, MARY ROSE
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ROSE
Last Name:BARTKOWIAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:BARTKOWIAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:6216 KEVIN DR
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-1717
Mailing Address - Country:US
Mailing Address - Phone:810-623-8324
Mailing Address - Fax:
Practice Address - Street 1:6216 KEVIN DR
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-1717
Practice Address - Country:US
Practice Address - Phone:810-623-8324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010599551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical