Provider Demographics
NPI:1659898526
Name:ARBOR PSYCHOLOGY GROUP OF NORTHVILLE, PLLC
Entity Type:Organization
Organization Name:ARBOR PSYCHOLOGY GROUP OF NORTHVILLE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:BAMBERY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:734-738-0897
Mailing Address - Street 1:44450 PINETREE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-3869
Mailing Address - Country:US
Mailing Address - Phone:734-738-0897
Mailing Address - Fax:734-738-0897
Practice Address - Street 1:120 W MAIN ST STE 207
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-1584
Practice Address - Country:US
Practice Address - Phone:734-738-0897
Practice Address - Fax:734-738-0898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-23
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013977103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty