Provider Demographics
NPI:1265054837
Name:IVERSON, DEANNA MARIE (LMSW)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:MARIE
Last Name:IVERSON
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 1:2054 WICKHAM ST
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-1164
Mailing Address - Country:US
Mailing Address - Phone:313-598-2295
Mailing Address - Fax:
Practice Address - Street 1:315 N CENTER ST
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-1277
Practice Address - Country:US
Practice Address - Phone:313-656-4052
Practice Address - Fax:313-656-4053
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-17
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011073741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical