Supan, Maritaconstance

Supan, Maritaconstance is an sole proprietor health care provider with primary practice located at 934 Mason St , Dearborn MI 48124-2215. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Clinical Child & Adolescent. Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Supan, Maritaconstance can be contacted via phone (313) 278-8053.

Contact Information

Primary practice address
934 Mason St Dearborn MI 48124-2215
Phone: (313) 278-8053
Fax: (313) 278-8053
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 6301008934 Michigan
Behavioral Health & Social Service Providers / Clinical Child & Adolescent 103TC2200X 6301008934 Michigan

Profile Details

NPI number 1063663714
LBN Legal business name Supan, Maritaconstance
Credentials PH.D., LLP, DAPA
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 30th, 2008
Last updated Sep 30th, 2008 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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