Provider Demographics
NPI:1508638792
Name:NORTHVILLE PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:NORTHVILLE PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BUSWINKA
Authorized Official - Suffix:
Authorized Official - Credentials:LLP
Authorized Official - Phone:734-890-4057
Mailing Address - Street 1:8355 BERWICK DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-3852
Mailing Address - Country:US
Mailing Address - Phone:734-890-4057
Mailing Address - Fax:
Practice Address - Street 1:8355 BERWICK DR
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-3852
Practice Address - Country:US
Practice Address - Phone:734-890-4057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty