Healthcare Provider Details

I. General information

NPI: 1760804447
Provider Name (Legal Business Name): RISARG HUFF LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2014
Last Update Date: 01/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3430 3RD ST
DETROIT MI
48201-2202
US

IV. Provider business mailing address

3866 AUDUBON RD
DETROIT MI
48224-2749
US

V. Phone/Fax

Practice location:
  • Phone: 313-832-3100
  • Fax: 313-832-5271
Mailing address:
  • Phone: 313-832-3100
  • Fax: 313-832-5271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801063609
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: