Provider Demographics
NPI:1790183861
Name:ALLISON SHAPIRO CARDEW, LLC
Entity Type:Organization
Organization Name:ALLISON SHAPIRO CARDEW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHILD THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:SHAPIRO
Authorized Official - Last Name:CARDEW
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:248-802-0445
Mailing Address - Street 1:33493 W 14 MILE RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-1587
Mailing Address - Country:US
Mailing Address - Phone:248-851-5437
Mailing Address - Fax:248-592-1378
Practice Address - Street 1:33493 W 14 MILE RD
Practice Address - Street 2:SUITE 130
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-1587
Practice Address - Country:US
Practice Address - Phone:248-851-5437
Practice Address - Fax:248-592-1378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-05
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009800103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty