Provider Demographics
NPI:1891028254
Name:SRIPADA, REBECCA KAUFMAN (PHD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:KAUFMAN
Last Name:SRIPADA
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 1:2800 PLYMOUTH RD
Mailing Address - Street 2:BLDG 16, 2ND FLOOR
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-2800
Mailing Address - Country:US
Mailing Address - Phone:734-222-7432
Mailing Address - Fax:
Practice Address - Street 1:2800 PLYMOUTH RD
Practice Address - Street 2:BLDG 16, 2ND FLOOR
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-2800
Practice Address - Country:US
Practice Address - Phone:734-222-7432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015606103TC0700X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral