Provider Demographics
NPI:1649284514
Name:MURAWSKI, MARYANNE C (LMSW)
Entity type:Individual
Prefix:MS
First Name:MARYANNE
Middle Name:C
Last Name:MURAWSKI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:MARYANNE
Other - Middle Name:
Other - Last Name:MURAWSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:501 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48082-1064
Mailing Address - Country:US
Mailing Address - Phone:313-570-6996
Mailing Address - Fax:
Practice Address - Street 1:38600 VAN DYKE AVE STE 101
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-1171
Practice Address - Country:US
Practice Address - Phone:313-570-6996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801072854104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMM072854Medicaid
MIMM072854OtherLICENSE