Provider Demographics
NPI:1851414213
Name:MARABLE, GARY (LMSW)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:
Last Name:MARABLE
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30172 WARREN RD APT 89N
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-2901
Mailing Address - Country:US
Mailing Address - Phone:313-483-2915
Mailing Address - Fax:
Practice Address - Street 1:30172 WARREN RD APT 89N
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-2901
Practice Address - Country:US
Practice Address - Phone:313-483-2915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010847871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8008980480OtherBCBS PIN