Provider Demographics
NPI:1821452061
Name:DENEAU, MARY (LMSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:DENEAU
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 1:7050 DEXTER ANN ARBOR RD STE 300
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MI
Mailing Address - Zip Code:48130-8659
Mailing Address - Country:US
Mailing Address - Phone:734-408-1191
Mailing Address - Fax:888-809-1470
Practice Address - Street 1:8658 MAGNOLIA WAY
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MI
Practice Address - Zip Code:48130-9106
Practice Address - Country:US
Practice Address - Phone:734-408-1191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-13
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC06229400104100000X
OHI.2203611104100000X
MI68010994891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker