Provider Demographics
NPI:1285478800
Name:MAZAREANU, MICHELLE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MAZAREANU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:COSMIN
Other - Middle Name:
Other - Last Name:MAZAREANU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2901 CORSTON RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-3714
Mailing Address - Country:US
Mailing Address - Phone:734-205-8452
Mailing Address - Fax:
Practice Address - Street 1:100 N STAEBLER RD STE B
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-9862
Practice Address - Country:US
Practice Address - Phone:734-252-6522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician