Provider Demographics
NPI:1659522159
Name:RENEE APPLEBAUM PH.D. PC
Entity Type:Organization
Organization Name:RENEE APPLEBAUM PH.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:ILENE
Authorized Official - Last Name:APPLEBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-203-9107
Mailing Address - Street 1:30150 TELEGRAPH RD
Mailing Address - Street 2:SUITE 255
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4519
Mailing Address - Country:US
Mailing Address - Phone:248-203-9107
Mailing Address - Fax:248-203-7117
Practice Address - Street 1:30150 TELEGRAPH RD
Practice Address - Street 2:SUITE 255
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4519
Practice Address - Country:US
Practice Address - Phone:248-203-9107
Practice Address - Fax:248-203-7117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009696103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty