Individual
MS. AMY LYNN WIDENBAUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW,LMSW,CSW,ACSW
Contact information
Practice address
15645 FARMINGTON RD, LIVONIA, MI 48154-2851
(248) 568-9680
(734) 425-6212
Mailing address
15645 FARMINGTON RD, LIVONIA, MI 48154-2851
(248) 568-9680
(734) 425-6212
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6801066237
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
476528
VALUE OPTIONS
MI
01
—
537109-000
MAGELLAN
MI
01
—
80-0-89-6782-0
BCBS
MI
Enumeration date
01/02/2007
Last updated
07/09/2007
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