Provider Demographics
NPI:1295520112
Name:ALREFAAI, MARYAM N
Entity type:Individual
Prefix:
First Name:MARYAM
Middle Name:N
Last Name:ALREFAAI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7651 PAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1034
Mailing Address - Country:US
Mailing Address - Phone:313-784-2601
Mailing Address - Fax:
Practice Address - Street 1:23500 PARK ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2598
Practice Address - Country:US
Practice Address - Phone:313-694-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBACB1048725106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician