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General NPI Number Information
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NPI Number | 1336290634
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Entity Type | Individual
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Provider Name | MATTHEW BERNARD DUSSIA LMSW
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Gender | Male
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Dates
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Enumeration Date | 01/15/2007
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Last Update Date | 11/10/2022
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Provider Practice Location Address
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Address Line | 5818 N COOLIDGE AVE
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City | HARRISON
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State | MI
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Zip | 48625-8679
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Country | US
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Telephone | 989-539-3841
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Fax |
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Provider Business Mailing Address
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Address Line | 5818 N COOLIDGE AVE
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City | HARRISON
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State | MI
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Zip | 48625-8679
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Country | US
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Telephone | 989-430-7495
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Fax | 989-539-2143
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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 | 6801058358
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License Number State | MI
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