Provider Demographics
NPI:1598778375
Name:BELONGEA, MARY JO (MSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JO
Last Name:BELONGEA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:657 WATERSEDGE DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-2514
Mailing Address - Country:US
Mailing Address - Phone:734-417-8438
Mailing Address - Fax:
Practice Address - Street 1:201 N ASHLEY ST
Practice Address - Street 2:SUITE 2
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-1310
Practice Address - Country:US
Practice Address - Phone:734-417-8438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010255101YM0800X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health