Mary Petersen, MSW, ACSW
Individual provider Active NPI Clinical Social Worker · New Haven, MI
NPI 1003986068 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1003986068
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 6801080062 (MI)
- Practice address
- 58144 Gratiot Ave
New Haven, MI 48048 - Phone
- (810) 794-4982
- Fax
- (810) 794-4407
- NPI assigned
- Nov 8, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6801080062 | MI | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Comprehensive Youth Services Inc | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 6801080062 | MI | Yes |
Addresses
Primary practice location
58144 Gratiot Ave
New Haven, MI 48048
Mailing address
555 Saint Clair River Dr
Algonac, MI 48001-1802
Phone (810) 794-4982
Other providers in New Haven, MI
- New Haven Dental PLLC
- Nurse Doula Christine Cares Staffing , LLC
- Melissa Olsen
- Cross Anthony Orow
- Peak Autism Center
- Alisa Puvalowski
- Chelsea Rhodey
- Rite Aid of Michigan Inc
- Mary Rule
- Sacred Heart Rehabilitation Center, Inc.
All providers in New Haven, MI · Clinical Social Worker in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.