Provider Demographics
NPI:1306096953
Name:MARIUTZA, GEORGE M (LLMSW CADCM)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:M
Last Name:MARIUTZA
Suffix:
Gender:M
Credentials:LLMSW CADCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PETERBORO ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2722
Mailing Address - Country:US
Mailing Address - Phone:313-833-4627
Mailing Address - Fax:
Practice Address - Street 1:171 DAWSON ST
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:MI
Practice Address - Zip Code:48471-1062
Practice Address - Country:US
Practice Address - Phone:810-648-4098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-19
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1916956104100000X
MI1-04857101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)