Provider Demographics
NPI:1689918963
Name:NUSBAUM, HILLARY (MSW)
Entity type:Individual
Prefix:
First Name:HILLARY
Middle Name:
Last Name:NUSBAUM
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 1:4950 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-1142
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3377 BEECH DR
Practice Address - Street 2:APT. 7208
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48359-2352
Practice Address - Country:US
Practice Address - Phone:248-505-8754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010925501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical