Provider Demographics
NPI:1851943278
Name:SCHULIST, ROSE IRENE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:IRENE
Last Name:SCHULIST
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50202 PROCTOR RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-1010
Mailing Address - Country:US
Mailing Address - Phone:734-945-4975
Mailing Address - Fax:
Practice Address - Street 1:50202 PROCTOR RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-1010
Practice Address - Country:US
Practice Address - Phone:734-945-4975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010855031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical