Provider Demographics
NPI:1295897072
Name:JOGANIC, MARY ANN (LMSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:JOGANIC
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 1:5681 MAYBURN ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-3207
Mailing Address - Country:US
Mailing Address - Phone:313-274-5640
Mailing Address - Fax:
Practice Address - Street 1:23933 ALLEN RD
Practice Address - Street 2:SUITE 3
Practice Address - City:WOODHAVEN
Practice Address - State:MI
Practice Address - Zip Code:48183-3372
Practice Address - Country:US
Practice Address - Phone:313-410-5672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010752091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801075209OtherLMSW