Provider Demographics
NPI:1871183863
Name:DUBERSTEIN, ADAM (MA, TLLP)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:
Last Name:DUBERSTEIN
Suffix:
Gender:M
Credentials:MA, TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23200 JOHN R RD UNIT 1074
Mailing Address - Street 2:
Mailing Address - City:HAZEL PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48030-7043
Mailing Address - Country:US
Mailing Address - Phone:248-658-8070
Mailing Address - Fax:
Practice Address - Street 1:26105 ORCHARD LAKE RD STE 203
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-4578
Practice Address - Country:US
Practice Address - Phone:248-658-8070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-22
Last Update Date:2021-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6352000080103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical