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General NPI Number Information
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NPI Number | 1053578179
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Entity Type | Organization
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Legal Business Name | AMY L. WIDENBAUM, LMSW, PC
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Dates
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Enumeration Date | 05/16/2008
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Last Update Date | 08/26/2013
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Provider Practice Location Address
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Address Line | 18420 FARMINGTON RD
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City | LIVONIA
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State | MI
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Zip | 48152-3588
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Country | US
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Telephone | 248-568-9680
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Fax | 734-425-6212
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Provider Business Mailing Address
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Address Line | 18420 FARMINGTON RD
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City | LIVONIA
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State | MI
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Zip | 48152-3588
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Country | US
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Telephone | 248-568-9680
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Fax |
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Authorized Official
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Title or Position | CLINICAL THERAPIST
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Name | MS. AMY L WIDENBAUM
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Credential | LMSW
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Telephone | 248-568-9680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801066237
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License Number State | MI
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