Provider Demographics
NPI:1497083711
Name:ADRIANNE M CAMERO-SULAK, PSY.D., PLLC
Entity Type:Organization
Organization Name:ADRIANNE M CAMERO-SULAK, PSY.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CAMERO-SULAK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:734-355-4439
Mailing Address - Street 1:555 E WILLIAM ST
Mailing Address - Street 2:SUITE 18-H
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-2441
Mailing Address - Country:US
Mailing Address - Phone:734-355-4439
Mailing Address - Fax:734-429-9584
Practice Address - Street 1:555 E WILLIAM ST
Practice Address - Street 2:SUITE 18-H
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2441
Practice Address - Country:US
Practice Address - Phone:734-355-4439
Practice Address - Fax:734-429-9584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-24
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011464103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI1103Medicare PIN