Provider Demographics
NPI:1134163322
Name:SAVICKAS, PAUL R (PHD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:R
Last Name:SAVICKAS
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 1:14600 KING ROAD
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-7952
Mailing Address - Country:US
Mailing Address - Phone:734-479-2708
Mailing Address - Fax:734-479-2736
Practice Address - Street 1:14600 KING ROAD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48193-7952
Practice Address - Country:US
Practice Address - Phone:734-479-2708
Practice Address - Fax:734-479-2736
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005946103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H24726OtherBLUE CROSS BLUE SHIELD
MI0H24726OtherBLUE CROSS BLUE SHIELD
MI0M82290Medicare ID - Type Unspecified