Provider Demographics
NPI:1700389418
Name:VARADY, MICHELE VALERIE
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:VALERIE
Last Name:VARADY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 WOODWARD HEIGHTS BLVD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT RIDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48069-1247
Mailing Address - Country:US
Mailing Address - Phone:248-219-8829
Mailing Address - Fax:
Practice Address - Street 1:700 N OLD WOODWARD AVE STE 300
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-1338
Practice Address - Country:US
Practice Address - Phone:248-642-8263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-09
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301017059103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical