Provider Demographics
NPI:1134314529
Name:HAEMMERLE, CHRISTINA (PHD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:HAEMMERLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2565 S ROCHESTER RD
Mailing Address - Street 2:SUITE 108B
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-4472
Mailing Address - Country:US
Mailing Address - Phone:248-852-7907
Mailing Address - Fax:248-852-7791
Practice Address - Street 1:2565 S ROCHESTER RD
Practice Address - Street 2:SUITE 108B
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-4472
Practice Address - Country:US
Practice Address - Phone:248-852-7907
Practice Address - Fax:248-852-7791
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI630101010779103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F33286OtherUPIN
MI0N62190Medicare PIN