Provider Demographics
NPI:1043348311
Name:ST JOSEPH MERCY BEHAVIORAL SERVICES
Entity Type:Organization
Organization Name:ST JOSEPH MERCY BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROSEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYS
Authorized Official - Phone:810-844-7300
Mailing Address - Street 1:3482 E DEAN RD
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48855-8234
Mailing Address - Country:US
Mailing Address - Phone:517-545-5752
Mailing Address - Fax:
Practice Address - Street 1:10299 GRAND RIVER RD
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-6541
Practice Address - Country:US
Practice Address - Phone:810-844-7311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service