Provider Demographics
NPI:1639558620
Name:ALLIANCE PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:ALLIANCE PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONINO
Authorized Official - Middle Name:
Authorized Official - Last Name:AGOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:248-678-8606
Mailing Address - Street 1:2175 LONDON BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-4234
Mailing Address - Country:US
Mailing Address - Phone:248-678-8606
Mailing Address - Fax:
Practice Address - Street 1:1135 W UNIVERSITY DR STE 445
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1871
Practice Address - Country:US
Practice Address - Phone:224-595-8416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-22
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015487103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty