Provider Demographics
NPI:1982681573
Name:DOOLEY, JOHN ANTHONY (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANTHONY
Last Name:DOOLEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2799 W GRAND BLVD
Mailing Address - Street 2:PAIN CLINIC I-3
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2608
Mailing Address - Country:US
Mailing Address - Phone:313-916-7949
Mailing Address - Fax:313-916-8023
Practice Address - Street 1:2799 W GRAND BLVD
Practice Address - Street 2:PAIN CLINIC I-3
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:313-916-7949
Practice Address - Fax:313-916-8023
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301003951103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI038522OtherVALUE OPTIONS PROVIDER ID
MI68 0E0 4569OtherBLUE CROSS PROVIDER IDN
MI68 0E0 4569OtherBLUE CROSS PROVIDER IDN
MIR67219Medicare UPIN