Provider Demographics
NPI:1104064948
Name:MYLER, DANA MARIE (LMSW)
Entity type:Individual
Prefix:MS
First Name:DANA
Middle Name:MARIE
Last Name:MYLER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22610 MORLEY AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2106
Mailing Address - Country:US
Mailing Address - Phone:313-384-7081
Mailing Address - Fax:
Practice Address - Street 1:22610 MORLEY AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2106
Practice Address - Country:US
Practice Address - Phone:313-384-7081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-02
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1104064948252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency