Provider Demographics
NPI:1952373417
Name:MUSCAT, ANGELINA MARIE (MSW)
Entity type:Individual
Prefix:
First Name:ANGELINA
Middle Name:MARIE
Last Name:MUSCAT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41125 IVYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-2628
Mailing Address - Country:US
Mailing Address - Phone:734-420-2516
Mailing Address - Fax:
Practice Address - Street 1:2200 N CANTON CENTER RD
Practice Address - Street 2:SUITE 250
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-5065
Practice Address - Country:US
Practice Address - Phone:734-981-8820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN88750001Medicare ID - Type UnspecifiedMEMBER#