Provider Demographics
NPI:1639228000
Name:PSYCHIATRIC SERVICES OF GROSSE POINTE
Entity Type:Organization
Organization Name:PSYCHIATRIC SERVICES OF GROSSE POINTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DARRYL
Authorized Official - Last Name:ADAMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-252-2616
Mailing Address - Street 1:25509 KELLY RD STE A
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-5823
Mailing Address - Country:US
Mailing Address - Phone:586-252-2616
Mailing Address - Fax:313-563-8443
Practice Address - Street 1:25509 KELLY RD STE A
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-5823
Practice Address - Country:US
Practice Address - Phone:586-252-2616
Practice Address - Fax:313-563-8443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006332103T00000X
MI68010769061041C0700X
MI68010915571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM26670Medicare ID - Type Unspecified
MIOM85870Medicare PIN