Provider Demographics
NPI:1578861027
Name:THERESA J. CURTIN PH.D. P.C.
Entity Type:Organization
Organization Name:THERESA J. CURTIN PH.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CURTIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:269-552-9299
Mailing Address - Street 1:4415 DUKE ST. 1E
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008
Mailing Address - Country:US
Mailing Address - Phone:269-552-9299
Mailing Address - Fax:
Practice Address - Street 1:4415 DUKE ST STE 1E
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-3224
Practice Address - Country:US
Practice Address - Phone:269-552-9299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006728103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM69990Medicare PIN