Provider Demographics
NPI:1700054814
Name:CHERIAN, SAM (PHD)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:
Last Name:CHERIAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17105 W 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2104
Mailing Address - Country:US
Mailing Address - Phone:248-557-8390
Mailing Address - Fax:248-557-6427
Practice Address - Street 1:17105 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2104
Practice Address - Country:US
Practice Address - Phone:248-557-8390
Practice Address - Fax:248-557-6427
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011838103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist