Provider Demographics
NPI:1497905947
Name:POZNANSKA-FREDERICK, DOROTA (MA, LLP)
Entity Type:Individual
Prefix:
First Name:DOROTA
Middle Name:
Last Name:POZNANSKA-FREDERICK
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43569 W ARBOR WAY DR
Mailing Address - Street 2:UNIT 144
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-1873
Mailing Address - Country:US
Mailing Address - Phone:734-397-5253
Mailing Address - Fax:
Practice Address - Street 1:43569 W ARBOR WAY DR
Practice Address - Street 2:UNIT 144
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-1873
Practice Address - Country:US
Practice Address - Phone:734-397-5253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-21
Last Update Date:2008-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1189348103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist