Provider Demographics
NPI:1568078137
Name:PODZIKOWSKI, CARLY MARIE
Entity Type:Individual
Prefix:MRS
First Name:CARLY
Middle Name:MARIE
Last Name:PODZIKOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1684 LITTLESTONE RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1955
Mailing Address - Country:US
Mailing Address - Phone:248-506-2713
Mailing Address - Fax:
Practice Address - Street 1:17320 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2100
Practice Address - Country:US
Practice Address - Phone:248-727-3456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-19
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1568078137102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst