Provider Demographics
NPI:1407479447
Name:LANDAU, RICHARD J (PHD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:LANDAU
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5340 PLYMOUTH RD STE 200
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9341
Mailing Address - Country:US
Mailing Address - Phone:734-646-8788
Mailing Address - Fax:
Practice Address - Street 1:5340 PLYMOUTH RD STE 200
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9341
Practice Address - Country:US
Practice Address - Phone:734-646-8788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-26
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071009794103TB0200X
MI6301018413103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral