Provider Demographics
NPI:1821077082
Name:GREENSHIELDS, SUSAN (PHD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:GREENSHIELDS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19855 OUTER DR
Mailing Address - Street 2:SUITE 103A
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2022
Mailing Address - Country:US
Mailing Address - Phone:313-359-3676
Mailing Address - Fax:
Practice Address - Street 1:19855 OUTER DR
Practice Address - Street 2:SUITE 103A
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2022
Practice Address - Country:US
Practice Address - Phone:313-359-3676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-15
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007742103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M16380Medicare PIN