Provider Demographics
NPI:1992910376
Name:BABUSHKIN, ANTON (LMSW, PHD)
Entity type:Individual
Prefix:DR
First Name:ANTON
Middle Name:
Last Name:BABUSHKIN
Suffix:
Gender:M
Credentials:LMSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 E 9 MILE RD
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-2065
Mailing Address - Country:US
Mailing Address - Phone:248-910-1815
Mailing Address - Fax:
Practice Address - Street 1:1603 E 9 MILE RD
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-2065
Practice Address - Country:US
Practice Address - Phone:248-514-4955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3434247Medicaid