Provider Demographics
NPI:1891907838
Name:TRAURIG, HENRY M (MA)
Entity Type:Individual
Prefix:MR
First Name:HENRY
Middle Name:M
Last Name:TRAURIG
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10734 ELGIN AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48070-1506
Mailing Address - Country:US
Mailing Address - Phone:248-496-8236
Mailing Address - Fax:
Practice Address - Street 1:905 S CENTER ST
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-3230
Practice Address - Country:US
Practice Address - Phone:248-644-8533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006840103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1558412551OtherGROUP NPI