Provider Demographics
NPI:1568988392
Name:ROUSSEAU, MICHEL LEVIN (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:MICHEL
Middle Name:LEVIN
Last Name:ROUSSEAU
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5905 GOLDEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4463
Mailing Address - Country:US
Mailing Address - Phone:952-546-0616
Mailing Address - Fax:952-593-1778
Practice Address - Street 1:13100 WAYZATA BLVD STE 400
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1821
Practice Address - Country:US
Practice Address - Phone:952-546-0616
Practice Address - Fax:952-593-1778
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN234891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical