Provider Demographics
NPI:1609540657
Name:BIRNBAUM, RICHARD (PHD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:BIRNBAUM
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 1:1540 EAST MEDICAL CENTER DRIVE
Mailing Address - Street 2:LEVEL 5
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-5318
Mailing Address - Country:US
Mailing Address - Phone:734-936-4220
Mailing Address - Fax:734-936-6897
Practice Address - Street 1:1540 EAST MEDICAL CENTER DRIVE
Practice Address - Street 2:LEVEL 5
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-5318
Practice Address - Country:US
Practice Address - Phone:734-936-4220
Practice Address - Fax:734-936-6897
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301018877103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist