Healthcare Provider Details

I. General information

NPI: 1063660181
Provider Name (Legal Business Name): REBECCA KARP ZUSEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 09/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40000 GRAND RIVER AVENUE SUITE 306
NOVI MI
48375
US

IV. Provider business mailing address

6623 PINE EAGLE LANE
WEST BLOOMFIELD MI
48322
US

V. Phone/Fax

Practice location:
  • Phone: 248-426-9900
  • Fax:
Mailing address:
  • Phone: 248-910-8283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801083725
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: