Provider Demographics
NPI:1427710938
Name:SCARSELLA, MARY ANNE (LMSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ANNE
Last Name:SCARSELLA
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 1:18416 MARTIN RD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4805
Mailing Address - Country:US
Mailing Address - Phone:586-360-5414
Mailing Address - Fax:
Practice Address - Street 1:1675 FAIRHOLME RD
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-2368
Practice Address - Country:US
Practice Address - Phone:313-244-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-12
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
68011040091041C0700X
MI6801104009104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty