Provider Demographics
NPI:1063464097
Name:CENTER FOR INDIVIDUAL & FAMILY THERAPY
Entity Type:Organization
Organization Name:CENTER FOR INDIVIDUAL & FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEEHY
Authorized Official - Suffix:
Authorized Official - Credentials:ACSW
Authorized Official - Phone:313-291-7000
Mailing Address - Street 1:21751 ECORSE RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-1846
Mailing Address - Country:US
Mailing Address - Phone:313-291-7000
Mailing Address - Fax:313-291-0942
Practice Address - Street 1:21751 ECORSE RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-1846
Practice Address - Country:US
Practice Address - Phone:313-291-7000
Practice Address - Fax:313-291-0942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0P16220Medicare PIN
0P16210Medicare PIN