Basic Information
| Provider Information | |||||||||
| NPI: | 1609133289 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HURWITZ | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25891 CHEYENNE DR | ||||||||
| Address2: | |||||||||
| City: | NOVI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483742363 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488774270 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 20300 CIVIC CENTER DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480764105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2489961055 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2012 | ||||||||
| LastUpdateDate: | 04/19/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801091021 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.