Healthcare Provider Details

I. General information

NPI: 1619028040
Provider Name (Legal Business Name): MICHELE L PUZZUOLI LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2007
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18303 E 10 MILE RD STE 200
ROSEVILLE MI
48066-4989
US

IV. Provider business mailing address

18303 E 10 MILE RD STE 200
ROSEVILLE MI
48066-4989
US

V. Phone/Fax

Practice location:
  • Phone: 800-693-1916
  • Fax:
Mailing address:
  • Phone: 800-693-1916
  • Fax: 248-422-1430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801086423
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: