MEDICARE: HILLARY NUSBAUM MSW

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	6801092550	MI

General Provider Information

NPI Number	:	1689918963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HILLARY NUSBAUM MSW

Provider Business Mailing Address
First Line	:	4950 HIGHLAND RD
Second Line	:
City	:	WATERFORD
State	:	MI
Zip	:	48328-1142
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3377 BEECH DR
Second Line	:	APT. 7208
City	:	LAKE ORION
State	:	MI
Zip	:	48359-2352
Country	:	US
Telephone Number	:	248-505-8754
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/26/2012
Last Update Date	:	03/05/2015

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