Provider Demographics
NPI:1972930139
Name:CARUSO-RUHL, JOSEPHINE ANNE (MA, LLP)
Entity Type:Individual
Prefix:MRS
First Name:JOSEPHINE
Middle Name:ANNE
Last Name:CARUSO-RUHL
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23871 WINGED FOOT WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-9083
Mailing Address - Country:US
Mailing Address - Phone:248-514-7713
Mailing Address - Fax:
Practice Address - Street 1:670 GRISWOLD ST
Practice Address - Street 2:STE. #3
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-2675
Practice Address - Country:US
Practice Address - Phone:248-347-3470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009864103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical