Provider Demographics
NPI:1093829004
Name:RUSCHAK, AMY E (MSW LMSW)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:E
Last Name:RUSCHAK
Suffix:
Gender:F
Credentials:MSW LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 EASTON DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178
Mailing Address - Country:US
Mailing Address - Phone:248-446-2416
Mailing Address - Fax:
Practice Address - Street 1:115 N CENTER ST SUITE 202
Practice Address - Street 2:HEGIRA NORTHVILLE COUNSELING CENTER
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167
Practice Address - Country:US
Practice Address - Phone:248-347-3470
Practice Address - Fax:248-347-2242
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801069693104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker