Provider Demographics
NPI:1396075701
Name:CEASAR, MARY ANN (LMSW, ACSW)
Entity type:Individual
Prefix:MISS
First Name:MARY
Middle Name:ANN
Last Name:CEASAR
Suffix:
Gender:F
Credentials:LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23520 CONDON ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2121
Mailing Address - Country:US
Mailing Address - Phone:248-259-4775
Mailing Address - Fax:
Practice Address - Street 1:23520 CONDON ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2121
Practice Address - Country:US
Practice Address - Phone:248-259-4775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010339841041C0700X
MI8848951601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801033984OtherLMSW
MI884895160OtherACSW