Provider Demographics
NPI:1053339036
Name:RYBERG, ERICK LEONARD (MSW)
Entity type:Individual
Prefix:
First Name:ERICK
Middle Name:LEONARD
Last Name:RYBERG
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30247 OVERDALE CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334
Mailing Address - Country:US
Mailing Address - Phone:248-895-6206
Mailing Address - Fax:248-254-3333
Practice Address - Street 1:30375 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334
Practice Address - Country:US
Practice Address - Phone:248-254-3332
Practice Address - Fax:248-254-3333
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010116131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP48610002Medicare PIN