Provider Demographics
NPI:1568679470
Name:SUGRUE, DENNIS P (PHD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:P
Last Name:SUGRUE
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 1:74 W LONG LAKE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-2769
Mailing Address - Country:US
Mailing Address - Phone:248-642-6066
Mailing Address - Fax:248-642-5739
Practice Address - Street 1:74 W LONG LAKE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-2769
Practice Address - Country:US
Practice Address - Phone:248-642-6066
Practice Address - Fax:248-642-5739
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301003771103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical