Provider Demographics
NPI:1083212559
Name:SZARAZ, AMY DIANE
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:DIANE
Last Name:SZARAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7645 FOSDICK RD
Mailing Address - Street 2:
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-9091
Mailing Address - Country:US
Mailing Address - Phone:734-635-7469
Mailing Address - Fax:
Practice Address - Street 1:7645 FOSDICK RD
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-9091
Practice Address - Country:US
Practice Address - Phone:734-635-7469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401017719101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional