Provider Demographics
NPI:1659408656
Name:FIRST RESOURCES SOUTHWEST
Entity Type:Organization
Organization Name:FIRST RESOURCES SOUTHWEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MASTER LEVEL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:MAURINE
Authorized Official - Last Name:LEVY-RUBINSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:586-274-0200
Mailing Address - Street 1:5472 CAROL RUN S
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2110
Mailing Address - Country:US
Mailing Address - Phone:248-496-1036
Mailing Address - Fax:586-274-0228
Practice Address - Street 1:5472 CAROL RUN S
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-2110
Practice Address - Country:US
Practice Address - Phone:248-496-1036
Practice Address - Fax:586-274-0228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health