Provider Demographics
NPI:1396894424
Name:CHRISTINA HAEMMERLE PHD PC
Entity type:Organization
Organization Name:CHRISTINA HAEMMERLE PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAEMMERLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:586-321-8115
Mailing Address - Street 1:55680 LANCEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-5808
Mailing Address - Country:US
Mailing Address - Phone:586-207-1069
Mailing Address - Fax:
Practice Address - Street 1:2565 S ROCHESTER RD
Practice Address - Street 2:SUITE 108B
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-4472
Practice Address - Country:US
Practice Address - Phone:248-852-7907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2010-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010779103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI350883000OtherMAGELLAN
MI0F33286Medicare UPIN
MI0N62190Medicare ID - Type Unspecified