Provider Demographics
NPI:1063936656
Name:BANDFIELD, MARY (LMSW, AASW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:BANDFIELD
Suffix:
Gender:F
Credentials:LMSW, AASW
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:BANDFIELD
Other - Last Name:SKENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW, AASW
Mailing Address - Street 1:521 OKEMOS ST
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-1224
Mailing Address - Country:US
Mailing Address - Phone:517-325-9979
Mailing Address - Fax:
Practice Address - Street 1:521 OKEMOS ST
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:MI
Practice Address - Zip Code:48854-1224
Practice Address - Country:US
Practice Address - Phone:517-325-9799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-26
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010974671041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty