Healthcare Provider Details

I. General information

NPI: 1487125837
Provider Name (Legal Business Name): JULIANNE MACZYNSKI RUFFER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2018
Last Update Date: 12/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34505 W 12 MILE RD
FARMINGTON HILLS MI
48331-3258
US

IV. Provider business mailing address

34505 W 12 MILE RD
FARMINGTON HILLS MI
48331-3258
US

V. Phone/Fax

Practice location:
  • Phone: 734-343-7500
  • Fax: 833-854-4439
Mailing address:
  • Phone: 734-343-7500
  • Fax: 833-854-4439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801015911
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: