Provider Demographics
NPI:1982965125
Name:SNOWDEN, MARILYN J (LMSW, MSW)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:J
Last Name:SNOWDEN
Suffix:
Gender:F
Credentials:LMSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23753 CLARKSON ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-2504
Mailing Address - Country:US
Mailing Address - Phone:248-355-0118
Mailing Address - Fax:
Practice Address - Street 1:37899 W 12 MILE RD
Practice Address - Street 2:SUITE 130
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-3048
Practice Address - Country:US
Practice Address - Phone:248-476-2229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010093241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical