Provider Demographics
NPI:1144535899
Name:CYRIL-SCHWARTZ, MARRY ROSE SANJANA (LMSW)
Entity type:Individual
Prefix:MS
First Name:MARRY ROSE
Middle Name:SANJANA
Last Name:CYRIL-SCHWARTZ
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 1:23400 MICHIGAN AVE
Mailing Address - Street 2:VILLAGE PLAZA - SUITE 235
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1924
Mailing Address - Country:US
Mailing Address - Phone:313-791-4855
Mailing Address - Fax:
Practice Address - Street 1:6 PARKLANE BLVD
Practice Address - Street 2:STE 695
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2776
Practice Address - Country:US
Practice Address - Phone:313-271-8170
Practice Address - Fax:313-271-8353
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-18
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801069068101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor