Organization
GARY J. FUSCIARDI, PHD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY JOSEPH FUSCIARDI PHD (CLINICAL PSYCHOLOGIST/ PRESIDENT)
(586) 323-0696
Entity
Organization
Contact information
Practice address
8061 21 MILE RD, SUITE #4, SHELBY TOWNSHIP, MI 48317-4311
(586) 323-0696
(586) 731-8393
Mailing address
52480 SHELBY RD, SHELBY TOWNSHIP, MI 48316-3163
(586) 323-0696
(586) 731-8393
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301005314
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
042893
VALUE OPTIONS PIN
MI
01
—
5088220
AETNA PIN
MI
01
—
68-0E02859-0
BLUE CROSS AND BLUE SHIELD OF MICHIGAN
MI
01
—
9496605
CIGNA PIN
MI
Enumeration date
09/28/2006
Last updated
06/02/2009
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