Provider Demographics
NPI:1861456352
Name:CHOWDHURY, ANN (LLP CAAC)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:CHOWDHURY
Suffix:
Gender:F
Credentials:LLP CAAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42035 WATERWHEEL RD
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-2248
Mailing Address - Country:US
Mailing Address - Phone:248-349-5381
Mailing Address - Fax:734-942-7977
Practice Address - Street 1:17177 N LAUREL PARK DR
Practice Address - Street 2:CRUZ CLINIC #131
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-2693
Practice Address - Country:US
Practice Address - Phone:734-462-3210
Practice Address - Fax:734-462-1024
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008230103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical