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General NPI Number Information
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NPI Number | 1093829004
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Entity Type | Individual
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Provider Name | AMY E RUSCHAK MSW LMSW
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Gender | Female
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 115 N CENTER ST SUITE 202 HEGIRA NORTHVILLE COUNSELING CENTER
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City | NORTHVILLE
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State | MI
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Zip | 48167
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Country | US
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Telephone | 248-347-3470
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Fax | 248-347-2242
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Provider Business Mailing Address
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Address Line | 155 EASTON DR
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City | SOUTH LYON
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State | MI
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Zip | 48178
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Country | US
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Telephone | 248-446-2416
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6801069693
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License Number State | MI
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