Healthcare Provider Details

I. General information

NPI: 1669703070
Provider Name (Legal Business Name): MARIAH ELIZABETH ANN ROOT LMSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2010
Last Update Date: 02/08/2026
Certification Date: 02/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2563 RAYMOND AVE SE
GRAND RAPIDS MI
49507-3928
US

IV. Provider business mailing address

2563 RAYMOND AVE SE
GRAND RAPIDS MI
49507-3928
US

V. Phone/Fax

Practice location:
  • Phone: 517-862-3456
  • Fax: 847-492-0320
Mailing address:
  • Phone: 517-862-3456
  • Fax: 847-492-0320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801106604
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.013339
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: