Provider Demographics
NPI:1700673894
Name:DUMKE, MARYA (LICSW MSW)
Entity type:Individual
Prefix:
First Name:MARYA
Middle Name:
Last Name:DUMKE
Suffix:
Gender:F
Credentials:LICSW MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6501 OLSON MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4948
Mailing Address - Country:US
Mailing Address - Phone:952-374-9984
Mailing Address - Fax:
Practice Address - Street 1:6501 OLSON MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-4948
Practice Address - Country:US
Practice Address - Phone:952-374-9984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN246541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty