Provider Demographics
NPI:1023310828
Name:RADZILOWSKI, SUSAN KYLE (MSW)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:KYLE
Last Name:RADZILOWSKI
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:FITZPATRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:19641 SILVER SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-5060
Mailing Address - Country:US
Mailing Address - Phone:248-943-2089
Mailing Address - Fax:248-618-8072
Practice Address - Street 1:19641 SILVER SPRING ST
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-5060
Practice Address - Country:US
Practice Address - Phone:248-943-2089
Practice Address - Fax:248-618-8072
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-30
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010198641041C0700X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool