Provider Demographics
NPI:1396885224
Name:SYTSMA, MARILYN S (LMSW)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:S
Last Name:SYTSMA
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 1:5574 BAY SHORE DR
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:MI
Mailing Address - Zip Code:49777-8465
Mailing Address - Country:US
Mailing Address - Phone:989-595-3282
Mailing Address - Fax:
Practice Address - Street 1:112 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-2812
Practice Address - Country:US
Practice Address - Phone:989-358-9393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010663221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical