Provider Demographics
NPI:1710189147
Name:PSYCHOLOGY ASSOCIATES OF MICHIGAN PC
Entity Type:Organization
Organization Name:PSYCHOLOGY ASSOCIATES OF MICHIGAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:E
Authorized Official - Last Name:MONICATTI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:248-514-5371
Mailing Address - Street 1:1708 ROSELAND AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-3978
Mailing Address - Country:US
Mailing Address - Phone:248-514-5371
Mailing Address - Fax:
Practice Address - Street 1:1708 ROSELAND AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-3978
Practice Address - Country:US
Practice Address - Phone:248-514-5371
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011291103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIDF3207OtherMEDICARE RR
MI680F332420OtherBCBS
MI680F332420OtherBCBS