Provider Demographics
NPI:1548569049
Name:PASCIAK, ADAM R (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:R
Last Name:PASCIAK
Suffix:
Gender:M
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3604 CLARKSTON RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48348-5215
Mailing Address - Country:US
Mailing Address - Phone:248-595-9969
Mailing Address - Fax:248-814-0361
Practice Address - Street 1:3604 CLARKSTON RD
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348-5215
Practice Address - Country:US
Practice Address - Phone:248-595-9969
Practice Address - Fax:248-814-0361
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-23
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015095103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI750910402OtherBLUE CROSS OUT OF STATE
MI032919Medicaid
MI750910402OtherBCBSFED
MI750910402OtherBCBS CHRYSLER
MI750910402OtherBLUE CROSS TRUST
MI750910402OtherBCBS MICHIGAN
MIXX19153OtherHEALTHPLUS OF MICHIGAN