Provider Demographics
NPI:1760157549
Name:VANDENBOOM, MARIA (LMSW)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:VANDENBOOM
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 1:5896 HARPER RD
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842-8617
Mailing Address - Country:US
Mailing Address - Phone:517-281-8558
Mailing Address - Fax:
Practice Address - Street 1:5896 HARPER RD
Practice Address - Street 2:
Practice Address - City:HOLT
Practice Address - State:MI
Practice Address - Zip Code:48842-8617
Practice Address - Country:US
Practice Address - Phone:517-281-8558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010601601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical