Gary J. Fusciardi, PHD PC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301005314 Issued in MI

Legal business name

GARY J. FUSCIARDI, PHD PC

Practice address

8061 21 Mile Rd
Suite #4
Shelby Township, MI 48317-4311

Phone

(586) 323-0696

Fax

(586) 731-8393

NPI assigned

Sep 28, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Gary Joseph Fusciardi, PHD

Title

Clinical Psychologist/ President

Phone

(586) 323-0696

Specialties & licenses 1

Addresses

Other identifiers 4

Locations

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1243900800000",
    "number": "1669564837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "52480 SHELBY RD",
            "city": "SHELBY TOWNSHIP",
            "state": "MI",
            "postal_code": "483163163",
            "telephone_number": "586-323-0696",
            "fax_number": "586-731-8393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8061 21 MILE RD",
            "address_2": "SUITE #4",
            "city": "SHELBY TOWNSHIP",
            "state": "MI",
            "postal_code": "483174311",
            "telephone_number": "586-323-0696",
            "fax_number": "586-731-8393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARY J. FUSCIARDI, PHD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-28",
        "last_updated": "2009-06-02",
        "status": "A",
        "authorized_official_last_name": "FUSCIARDI",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST/ PRESIDENT",
        "authorized_official_telephone_number": "586-323-0696",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301005314",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PIN",
            "identifier": "5088220",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA PIN",
            "identifier": "9496605",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS AND BLUE SHIELD OF MICHIGAN",
            "identifier": "68-0E02859-0",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS PIN",
            "identifier": "042893",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Peter J Galle
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• Saurabh Gandhi, D.O.
• Travis Gannon
• Joseph Michael Gargagliano, PTA
• Gary P Johnson PC
• Bella Gates
• Catherine Lynn Gavan, PA-C
• Tyler David Gawlik
• Ronald D Geb, DDS

• Clinical Psychologist in Shelby Township, MI
• Providers in Shelby Township, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2009; 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.