Provider Demographics
NPI:1255421293
Name:ENGSTROM, MIRIAM ANN (PSYD, LP)
Entity type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:ANN
Last Name:ENGSTROM
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:MS
Other - First Name:MIRIAM
Other - Middle Name:
Other - Last Name:YEZBICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16924 SAINT PAUL ST
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1549
Mailing Address - Country:US
Mailing Address - Phone:313-690-2468
Mailing Address - Fax:
Practice Address - Street 1:16845 KERCHEVAL AVE STE 6B
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE PARK
Practice Address - State:MI
Practice Address - Zip Code:48230-1567
Practice Address - Country:US
Practice Address - Phone:313-690-2468
Practice Address - Fax:313-733-2468
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301019414103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical