Healthcare Provider Details

I. General information

NPI: 1124854104
Provider Name (Legal Business Name): MARY CASCARELLI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 W 7 MILE RD
DETROIT MI
48203-1967
US

IV. Provider business mailing address

1212 WATERMAN ST
DETROIT MI
48209-2258
US

V. Phone/Fax

Practice location:
  • Phone: 313-893-6172
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6851119836
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: