Provider Demographics
NPI:1417189523
Name:BERNADETTE S. KOVACH PH.D. PLLC
Entity Type:Organization
Organization Name:BERNADETTE S. KOVACH PH.D. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:STARR
Authorized Official - Last Name:KOVACH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:734-812-1157
Mailing Address - Street 1:5675 WOODLAND PASS
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48301-1230
Mailing Address - Country:US
Mailing Address - Phone:734-812-1157
Mailing Address - Fax:
Practice Address - Street 1:31731 NORTHWESTERN HWY STE 110E
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-1654
Practice Address - Country:US
Practice Address - Phone:734-812-1157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-23
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012246103TC0700X
103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysisGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1548336324OtherNPPES
MIOH073475OtherBCBS
MI680H231360OtherBCBS