Provider Demographics
NPI:1427432830
Name:KUSLUSKI, DEBRA (MSSA, LMSW)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:KUSLUSKI
Suffix:
Gender:F
Credentials:MSSA, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 WILSHIRE DR STE 175
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-1590
Mailing Address - Country:US
Mailing Address - Phone:800-693-1916
Mailing Address - Fax:
Practice Address - Street 1:41700 GARDENBROOK RD STE 110
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1320
Practice Address - Country:US
Practice Address - Phone:800-693-1916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010974441041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical