Provider Demographics
NPI:1639259021
Name:CAMERO-SULAK, ADRIANNE MARIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ADRIANNE
Middle Name:MARIE
Last Name:CAMERO-SULAK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:376 OAK BROOK CT
Mailing Address - Street 2:
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-1579
Mailing Address - Country:US
Mailing Address - Phone:734-355-4439
Mailing Address - Fax:734-429-9584
Practice Address - Street 1:555 E WILLIAM ST
Practice Address - Street 2:SUITE 18-H
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2441
Practice Address - Country:US
Practice Address - Phone:734-355-4439
Practice Address - Fax:734-429-9584
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011464103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI795-8733OtherAETNA PIN NUMBER
MI680H112680OtherBCBS PIN NUMBER
MI133618OtherPREFERRED CHOICES PPO PIN
MI791860000OtherMAGELLAN MIS NUMBER