Provider Demographics
NPI:1598823379
Name:MESZAROS, DONNA MARIE D (PHD)
Entity Type:Individual
Prefix:DR
First Name:DONNA MARIE
Middle Name:D
Last Name:MESZAROS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6748 ARDSLEY DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3026
Mailing Address - Country:US
Mailing Address - Phone:734-981-5886
Mailing Address - Fax:
Practice Address - Street 1:40000 GRAND RIVER AVE.
Practice Address - Street 2:SUITE 306
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2137
Practice Address - Country:US
Practice Address - Phone:248-426-9900
Practice Address - Fax:248-426-9950
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2008-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009817103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI68-0-F3-3252-0OtherBLUE CROSS BLUE SHIELD
MI0M86060OtherMEDICARE ID
11283595OtherCAQH
MI68-0-F3-3252-0OtherBLUE CROSS BLUE SHIELD