Provider Demographics
NPI:1568511368
Name:ARCHAMBAULT, RONALD T (MSW)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:T
Last Name:ARCHAMBAULT
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10435 LASALLE BLVD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48070-1119
Mailing Address - Country:US
Mailing Address - Phone:248-543-2220
Mailing Address - Fax:
Practice Address - Street 1:10435 LASALLE BLVD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON WOODS
Practice Address - State:MI
Practice Address - Zip Code:48070-1119
Practice Address - Country:US
Practice Address - Phone:248-543-2220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010166441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical