Provider Demographics
NPI:1013520550
Name:GRETTENBERGER, MARY MOONEY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MOONEY
Last Name:GRETTENBERGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 455
Mailing Address - Street 2:
Mailing Address - City:ARMADA
Mailing Address - State:MI
Mailing Address - Zip Code:48005-0455
Mailing Address - Country:US
Mailing Address - Phone:158-644-3183
Mailing Address - Fax:
Practice Address - Street 1:51145 WASHINGTON ST STE H
Practice Address - Street 2:
Practice Address - City:NEW BALTIMORE
Practice Address - State:MI
Practice Address - Zip Code:48047-2100
Practice Address - Country:US
Practice Address - Phone:586-307-4659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011153541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical