Provider Demographics
NPI:1760545131
Name:PSYCHOLOGY ASSOCIATES OF THE KEWEENAW PC
Entity Type:Organization
Organization Name:PSYCHOLOGY ASSOCIATES OF THE KEWEENAW PC
Other - Org Name:PSYCHOLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:SHARKEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHDLP
Authorized Official - Phone:906-337-6839
Mailing Address - Street 1:56730 CALUMET AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:CALUMET
Mailing Address - State:MI
Mailing Address - Zip Code:49913-2968
Mailing Address - Country:US
Mailing Address - Phone:906-337-6839
Mailing Address - Fax:906-337-0944
Practice Address - Street 1:56730 CALUMET AVE
Practice Address - Street 2:SUITE F
Practice Address - City:CALUMET
Practice Address - State:MI
Practice Address - Zip Code:49913-2968
Practice Address - Country:US
Practice Address - Phone:906-337-6839
Practice Address - Fax:906-337-0944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION94530Medicare ID - Type Unspecified