NPIMap

Individual provider Active NPI

Marilyn Denise Sanders, LMSW, MACRO

  • Clinical Social Worker
  • Southfield, MI
National Provider Identifier
1659385755
Registry record updated Nov 29, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801059552 Issued in MI
Practice address
17336 W. 12 Mile Road
103
Southfield, MI 48076
Phone
(248) 796-1217
NPI assigned
Jul 27, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 29, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 6801059552 MI Primary

Addresses

Primary practice location

17336 W. 12 Mile Road
103
Southfield, MI 48076

Mailing address

16500 North Park Drive 501
501
Southfield, MI 48075
Phone (248) 793-1217

Other identifiers 6

IdentifierTypeStateIssuer
0898005OtherMIBLUE CROSS BLUE SHIELD/BLUE CARE NETWORK
562276OtherMIVALUE OPTIONS
0P15280OtherMIMEDICARE PART - B
600538229OtherMIMAGELLAN BEHAVIORAL HEALTH SERVICES
59557OtherMIHEALTH PLAN OF MICHIGAN, INC.
80-0-89-7195OtherMIBLUE CROSS BLUE SHIELD /BLUE CARE NETWORK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
New Center Community Mental Health Services Past Accepting new patients
New Center Community Mental Health Services PastSince Sep 2, 2008 Accepting new patients
MDS Devine Counseling Services PastSince Jan 1, 1990 Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1322524800000",
    "number": "1659385755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16500 NORTH PARK DRIVE 501",
            "address_2": "501",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "48075",
            "telephone_number": "248-793-1217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17336 W. 12 MILE ROAD",
            "address_2": "103",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "48076",
            "telephone_number": "248-796-1217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDERS",
        "first_name": "MARILYN",
        "middle_name": "DENISE",
        "name_prefix": "Ms.",
        "credential": "LMSW, MACRO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-27",
        "last_updated": "2011-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801059552",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD/BLUE CARE NETWORK",
            "identifier": "0898005",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "562276",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART - B",
            "identifier": "0P15280",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN BEHAVIORAL HEALTH SERVICES",
            "identifier": "600538229",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PLAN OF MICHIGAN, INC.",
            "identifier": "59557",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD /BLUE CARE NETWORK",
            "identifier": "80-0-89-7195",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.