Justin David Petrusak, LMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801090356 Issued in MI

Practice address

4756 Cass Ave
Detroit, MI 48201-2357

Phone

(313) 577-4409

NPI assigned

Jan 16, 2014

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1389830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1457395200000",
    "number": "1316369937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9428 MCDOUGALL ST FL 2",
            "city": "HAMTRAMCK",
            "state": "MI",
            "postal_code": "482123564",
            "telephone_number": "586-214-4019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4756 CASS AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012357",
            "telephone_number": "313-577-4409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRUSAK",
        "first_name": "JUSTIN",
        "middle_name": "DAVID",
        "name_prefix": "Mr.",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-01-16",
        "last_updated": "2016-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801090356",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christy A Petroff, MD
• Labina Petrovska, MD
• Samantha Rose Petrovski
• Louise Fraser Petrucci, RN
• Alicia Haley Petrunak
• John Paul Petrykowski, DO
• Robert Pettaway
• Jimeka Pettes, MD
• Shania Petticord
• Shanise Yvonne Petticord

• Clinical Social Worker in Detroit, MI
• Providers in Detroit, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.