MEDICARE: SUSAN H. DEUTSCH PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1407188139
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSAN H. DEUTSCH PLLC

Provider Business Mailing Address
First Line	:	31219 OAK VALLEY DR
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48331-4402
Country	:	US
Telephone Number	:	248-563-7004
Fax Number	:	248-669-1925

Provider Business Practice Location Address
First Line	:	55 N POND DR
Second Line	:	SUITE 6
City	:	WALLED LAKE
State	:	MI
Zip	:	48390-3080
Country	:	US
Telephone Number	:	248-669-1900
Fax Number	:	248-669-1925

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	MS. SUSAN H. DEUTSCH
Credential	:	L.M.S.W, B.C.D
Telephone Number	:	248-563-7004

Provider Enumeration Date	:	02/05/2010
Last Update Date	:	02/10/2010

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