Provider Demographics
NPI:1649970492
Name:CSUTA-GALISZ, SZANDRA
Entity type:Individual
Prefix:MRS
First Name:SZANDRA
Middle Name:
Last Name:CSUTA-GALISZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1346 SHAKER DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-6121
Mailing Address - Country:US
Mailing Address - Phone:248-781-5306
Mailing Address - Fax:
Practice Address - Street 1:4410 W 13 MILE RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6515
Practice Address - Country:US
Practice Address - Phone:248-549-4339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician