| Gary J. Fusciardi, Phd Pc | |
|
8061 21 Mile Rd Suite #4 Shelby Township MI 48317-4311 | |
| (586) 323-0696 | |
| (586) 731-8393 |
| Full Name | Gary J. Fusciardi, Phd Pc |
|---|---|
| Speciality | Psychologist |
| Location | 8061 21 Mile Rd, Shelby Township, Michigan |
| Authorized Official Name and Position | Gary Joseph Fusciardi (CLINICAL PSYCHOLOGIST/ PRESIDENT) |
| Authorized Official Contact | 5863230696 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gary J. Fusciardi, Phd Pc 52480 Shelby Rd Shelby Township MI 48316-3163 Ph: (586) 323-0696 | Gary J. Fusciardi, Phd Pc 8061 21 Mile Rd Suite #4 Shelby Township MI 48317-4311 Ph: (586) 323-0696 |
| NPI Number | 1669564837 |
|---|---|
| Provider Enumeration Date | 09/28/2006 |
| Last Update Date | 06/02/2009 |
| Medicare PECOS PAC ID | 8820096431 |
|---|---|
| Medicare Enrollment ID | O20061115000024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669564837 | NPI | - | NPPES |
| 5088220 | Other | MI | AETNA PIN |
| 9496605 | Other | MI | CIGNA PIN |
| 68-0E02859-0 | Other | MI | BLUE CROSS AND BLUE SHIELD OF MICHIGAN |
| 042893 | Other | MI | VALUE OPTIONS PIN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 6301005314 (Michigan) | Primary |
| Provider Name | Gary J Fusciardi |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1245299361 PECOS PAC ID: 0648278259 Enrollment ID: I20061115000028 |
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