Provider Demographics
NPI:1841363439
Name:VANDENBOOM, MARIANNE M (LMSW)
Entity type:Individual
Prefix:MRS
First Name:MARIANNE
Middle Name:M
Last Name:VANDENBOOM
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 1:323 N. STATE STREET
Mailing Address - Street 2:TUSCOLA BEHAVIORAL HEALTH
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723
Mailing Address - Country:US
Mailing Address - Phone:989-673-6191
Mailing Address - Fax:989-672-2199
Practice Address - Street 1:1332 PROSPECT AVENUE
Practice Address - Street 2:TUSCOLA BEHAVIORAL HEALTH
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48732
Practice Address - Country:US
Practice Address - Phone:989-673-6191
Practice Address - Fax:989-672-3170
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801073813101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health