Provider Demographics
NPI:1497812523
Name:HOBERMAN, MELVIN I (MA,LLP,CSW,CAC 1)
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:
Last Name:HOBERMAN
Suffix:I
Gender:M
Credentials:MA,LLP,CSW,CAC 1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6394 ROSE BLVD
Mailing Address - Street 2:
Mailing Address - City:W BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2290
Mailing Address - Country:US
Mailing Address - Phone:248-539-3228
Mailing Address - Fax:
Practice Address - Street 1:6394 ROSE BLVD
Practice Address - Street 2:
Practice Address - City:W BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-2290
Practice Address - Country:US
Practice Address - Phone:248-539-3228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-00252103TA0400X
MI6301002903103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801011116OtherLICENSE NO.
MI6801011116OtherLICENSE NO.
MIOP25740Medicare UPIN