Provider Demographics
NPI:1497944763
Name:LIFSON, STEVEN ADAM (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ADAM
Last Name:LIFSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 W MICHIGAN ST
Mailing Address - Street 2:SUITE 16
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2492
Mailing Address - Country:US
Mailing Address - Phone:989-400-9254
Mailing Address - Fax:
Practice Address - Street 1:304 W MICHIGAN ST
Practice Address - Street 2:SUITE 16
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2492
Practice Address - Country:US
Practice Address - Phone:989-400-9254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008996103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11281997OtherCAQH
MI0P29710Medicare PIN