Provider Demographics
NPI:1306327119
Name:CENTER FOR EATING DISORDER ASSESSMENT RECOVERY & SUPPORT LLC
Entity type:Organization
Organization Name:CENTER FOR EATING DISORDER ASSESSMENT RECOVERY & SUPPORT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER, CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZZANO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-654-8026
Mailing Address - Street 1:1750 S TELEGRAPH RD STE 102
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0177
Mailing Address - Country:US
Mailing Address - Phone:248-654-8026
Mailing Address - Fax:
Practice Address - Street 1:1750 S TELEGRAPH RD STE 102
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0177
Practice Address - Country:US
Practice Address - Phone:248-654-8026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)