Provider Demographics
NPI:1427003375
Name:LAKESIDE PSYCHOLOGICAL SERVICES, P.C.
Entity Type:Organization
Organization Name:LAKESIDE PSYCHOLOGICAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:ALSTERBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:586-677-7860
Mailing Address - Street 1:52759 WOODMILL DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042-5668
Mailing Address - Country:US
Mailing Address - Phone:586-677-7860
Mailing Address - Fax:586-677-7860
Practice Address - Street 1:52759 WOODMILL DR
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48042-5668
Practice Address - Country:US
Practice Address - Phone:586-677-7860
Practice Address - Fax:586-677-7860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002887103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIR67506Medicare UPIN