Provider Demographics
NPI:1558724088
Name:MARYBARTKOWIAK
Entity Type:Organization
Organization Name:MARYBARTKOWIAK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTKOWIAKSC
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:810-623-8324
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-01
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801059955251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health