Provider Demographics
NPI:1497260871
Name:GROUP PSYCHOTHERAPY, PC
Entity Type:Organization
Organization Name:GROUP PSYCHOTHERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEORA
Authorized Official - Middle Name:PNINA
Authorized Official - Last Name:BAR-LEVAV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-353-4818
Mailing Address - Street 1:29600 NORTHWESTERN HWY
Mailing Address - Street 2:100B
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1016
Mailing Address - Country:US
Mailing Address - Phone:248-353-4818
Mailing Address - Fax:248-353-8107
Practice Address - Street 1:29600 NORTHWESTERN HWY
Practice Address - Street 2:100B
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1016
Practice Address - Country:US
Practice Address - Phone:248-353-4818
Practice Address - Fax:248-353-8107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-07
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010541482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty