Provider Demographics
NPI:1730463522
Name:KOSAL, MARY JANE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:JANE
Last Name:KOSAL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15160 W 8 MILE RD
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-3007
Mailing Address - Country:US
Mailing Address - Phone:248-968-0100
Mailing Address - Fax:248-968-7163
Practice Address - Street 1:15160 W 8 MILE RD
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-3007
Practice Address - Country:US
Practice Address - Phone:248-968-0100
Practice Address - Fax:248-968-7163
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010586191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical