Provider Demographics
NPI:1720403686
Name:BORROUSCH, DARIA LINDA (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:DARIA
Middle Name:LINDA
Last Name:BORROUSCH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:DARIA
Other - Middle Name:LINDA
Other - Last Name:KINASZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:2799 W GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2608
Mailing Address - Country:US
Mailing Address - Phone:313-916-9754
Mailing Address - Fax:313-916-8281
Practice Address - Street 1:2799 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:313-916-9754
Practice Address - Fax:313-916-8281
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801082267104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical