Provider Demographics
NPI:1104988666
Name:URBAN, MARIANNE (MALLP)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:URBAN
Suffix:
Gender:F
Credentials:MALLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38120 HAZEL ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48045-3561
Mailing Address - Country:US
Mailing Address - Phone:586-263-2760
Mailing Address - Fax:586-263-2762
Practice Address - Street 1:43411 GARFIELD RD STE A
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-1152
Practice Address - Country:US
Practice Address - Phone:586-263-2760
Practice Address - Fax:586-263-2762
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist