Provider Demographics
NPI:1881603702
Name:STOCK, CARYL BRUNER (PSYD)
Entity type:Individual
Prefix:DR
First Name:CARYL
Middle Name:BRUNER
Last Name:STOCK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 INDUSTRIAL DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-1741
Mailing Address - Country:US
Mailing Address - Phone:734-944-8300
Mailing Address - Fax:734-944-8303
Practice Address - Street 1:1235 INDUSTRIAL DR
Practice Address - Street 2:SUITE 4
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-1741
Practice Address - Country:US
Practice Address - Phone:734-944-8300
Practice Address - Fax:734-944-8303
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009184103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00360001Medicare ID - Type UnspecifiedMEMBER #, WPS MEDICARE B