Provider Demographics
NPI:1952901225
Name:NORTHERNER PSYCHOLOGICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:NORTHERNER PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:NORTHERNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-266-1183
Mailing Address - Street 1:6022 W MAPLE RD STE 403
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4408
Mailing Address - Country:US
Mailing Address - Phone:248-266-1183
Mailing Address - Fax:
Practice Address - Street 1:6022 W MAPLE RD STE 403
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4408
Practice Address - Country:US
Practice Address - Phone:248-266-1183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-27
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty