Provider Demographics
NPI:1982820957
Name:CARISSA GADEN, PH.D., P.C.
Entity Type:Organization
Organization Name:CARISSA GADEN, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:GADEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:586-772-9390
Mailing Address - Street 1:27941 HARPER AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-1535
Mailing Address - Country:US
Mailing Address - Phone:586-772-9390
Mailing Address - Fax:586-859-5300
Practice Address - Street 1:27941 HARPER AVE STE 102
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1535
Practice Address - Country:US
Practice Address - Phone:586-772-9390
Practice Address - Fax:586-859-5300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI71020000EO1883OtherBLUE CROSS BLUE SHIELD
MION81340Medicare ID - Type Unspecified