Provider Demographics
NPI:1124063946
Name:SAFRAN, JOHN S (EDD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:SAFRAN
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 NORTH HAMMOND
Mailing Address - Street 2:
Mailing Address - City:W BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323
Mailing Address - Country:US
Mailing Address - Phone:248-338-3788
Mailing Address - Fax:248-451-9089
Practice Address - Street 1:1750 S TELEGRAPH RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0166
Practice Address - Country:US
Practice Address - Phone:248-451-9085
Practice Address - Fax:248-451-9089
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI001769101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI040771OtherVALUE OPTIONS
MI040771OtherVALUE OPTIONS