1659385755 NPI number — MS. MARILYN DENISE SANDERS LMSW, MACRO

Table of content: MS. MARILYN DENISE SANDERS LMSW, MACRO (NPI 1659385755)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659385755 NPI number — MS. MARILYN DENISE SANDERS LMSW, MACRO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANDERS
Provider First Name:
MARILYN
Provider Middle Name:
DENISE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW, MACRO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659385755
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16500 NORTH PARK DRIVE 501
Provider Second Line Business Mailing Address:
501
Provider Business Mailing Address City Name:
SOUTHFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48075
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-793-1217
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17336 W. 12 MILE ROAD
Provider Second Line Business Practice Location Address:
103
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-796-1217
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  6801059552 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0898005 . This is a "BLUE CROSS BLUE SHIELD/BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 562276 . This is a "VALUE OPTIONS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0P15280 . This is a "MEDICARE PART - B" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 600538229 . This is a "MAGELLAN BEHAVIORAL HEALTH SERVICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 59557 . This is a "HEALTH PLAN OF MICHIGAN, INC." identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 80-0-89-7195 . This is a "BLUE CROSS BLUE SHIELD /BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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