Provider Demographics
NPI:1932958345
Name:JERUZAL, MICHAEL EARL JR (LMSW, SSW)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:EARL
Last Name:JERUZAL
Suffix:JR
Gender:M
Credentials:LMSW, SSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 N SAINT PAUL ST
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-1356
Mailing Address - Country:US
Mailing Address - Phone:231-233-2639
Mailing Address - Fax:
Practice Address - Street 1:604 N SAINT PAUL ST
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-1356
Practice Address - Country:US
Practice Address - Phone:231-233-2639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010912771041S0200X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool