Provider Demographics
NPI:1235490244
Name:BADHWAR, UMANG
Entity Type:Individual
Prefix:MISS
First Name:UMANG
Middle Name:
Last Name:BADHWAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1772 BRANDYWINE DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48304-1110
Mailing Address - Country:US
Mailing Address - Phone:917-306-6133
Mailing Address - Fax:
Practice Address - Street 1:29592 NORTHWESTERN HWY
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1019
Practice Address - Country:US
Practice Address - Phone:248-686-3352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361007750103T00000X
MI6301015255103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist