| Amy L. Widenbaum, Lmsw, Pc | |
|
18420 Farmington Rd Livonia MI 48152-3588 | |
| (248) 568-9680 | |
| (734) 425-6212 |
| Full Name | Amy L. Widenbaum, Lmsw, Pc |
|---|---|
| Speciality | Social Worker |
| Location | 18420 Farmington Rd, Livonia, Michigan |
| Authorized Official Name and Position | Amy L Widenbaum (CLINICAL THERAPIST) |
| Authorized Official Contact | 2485689680 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Amy L. Widenbaum, Lmsw, Pc 18420 Farmington Rd Livonia MI 48152-3588 Ph: (248) 568-9680 | Amy L. Widenbaum, Lmsw, Pc 18420 Farmington Rd Livonia MI 48152-3588 Ph: (248) 568-9680 |
| NPI Number | 1053578179 |
|---|---|
| Provider Enumeration Date | 05/16/2008 |
| Last Update Date | 08/26/2013 |
| Medicare PECOS PAC ID | 5496998411 |
|---|---|
| Medicare Enrollment ID | O20130823000487 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053578179 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 6801066237 (Michigan) | Primary |
| Provider Name | Amy L Widenbaum |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558428276 PECOS PAC ID: 5294628970 Enrollment ID: I20040205000989 |
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