Provider Demographics
NPI:1104943265
Name:RICH, DEBORAH A (PHD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:RICH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47818 VAN DYKE AVE
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-3373
Mailing Address - Country:US
Mailing Address - Phone:586-323-3620
Mailing Address - Fax:586-323-3568
Practice Address - Street 1:47818 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48317-3373
Practice Address - Country:US
Practice Address - Phone:586-323-3620
Practice Address - Fax:586-323-3568
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008204103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6301008204OtherSTATE LICENSE