Provider Demographics
NPI:1003040585
Name:JUDITH M. PASKIEWICZ, PH.D., P.C.
Entity Type:Organization
Organization Name:JUDITH M. PASKIEWICZ, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PASKIEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-642-3337
Mailing Address - Street 1:600 N OLD WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-1324
Mailing Address - Country:US
Mailing Address - Phone:248-642-3337
Mailing Address - Fax:
Practice Address - Street 1:600 N OLD WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-1324
Practice Address - Country:US
Practice Address - Phone:248-642-3337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008361103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0896038Medicare PIN