Provider Demographics
NPI:1801957220
Name:ASMUS, MARY ANN (LMSW ACSW)
Entity type:Individual
Prefix:MS
First Name:MARY ANN
Middle Name:
Last Name:ASMUS
Suffix:
Gender:F
Credentials:LMSW ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5836 DEER TRAIL DRIVE
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-8479
Mailing Address - Country:US
Mailing Address - Phone:231-275-5609
Mailing Address - Fax:231-946-6638
Practice Address - Street 1:902 W FRONT ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684
Practice Address - Country:US
Practice Address - Phone:231-631-4038
Practice Address - Fax:231-946-6638
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010175921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
0P28460Medicare ID - Type Unspecified