Provider Demographics
NPI:1740319342
Name:CHIMOVITZ, MARYRITA (LMSW, ACSW, CAC I)
Entity type:Individual
Prefix:
First Name:MARYRITA
Middle Name:
Last Name:CHIMOVITZ
Suffix:
Gender:F
Credentials:LMSW, ACSW, CAC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2383 MARGARET DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-8804
Mailing Address - Country:US
Mailing Address - Phone:810-629-0172
Mailing Address - Fax:
Practice Address - Street 1:6379 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:MI
Practice Address - Zip Code:48722-9566
Practice Address - Country:US
Practice Address - Phone:989-777-4357
Practice Address - Fax:989-777-7257
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801070050104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI01003253OtherHEALTH PLUS - BRIDGEPORT
MI0996911OtherHEALTH PLUS - SAGINAW