Provider Demographics
NPI:1851408777
Name:COSTINEW, BEVERLY A (PHD LP)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:A
Last Name:COSTINEW
Suffix:
Gender:F
Credentials:PHD LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31700 W 13 MILE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2166
Mailing Address - Country:US
Mailing Address - Phone:810-923-8402
Mailing Address - Fax:810-355-1337
Practice Address - Street 1:31700 W 13 MILE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2166
Practice Address - Country:US
Practice Address - Phone:810-923-8402
Practice Address - Fax:810-355-1337
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301003869103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP24790Medicare ID - Type Unspecified