Provider Demographics
NPI:1972627453
Name:STAPLETON, ANNA M (MA)
Entity Type:Individual
Prefix:MS
First Name:ANNA
Middle Name:M
Last Name:STAPLETON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45844 SOUTHWICK DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-6230
Mailing Address - Country:US
Mailing Address - Phone:734-495-9956
Mailing Address - Fax:
Practice Address - Street 1:2048 WASHTENAW RD
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1889
Practice Address - Country:US
Practice Address - Phone:734-751-3522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011710103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11561714OtherCAQH PROVIDER I.D.