Provider Demographics
NPI:1316115421
Name:JUDY M SOBCZAK PHD PC
Entity type:Organization
Organization Name:JUDY M SOBCZAK PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SOBCZAK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-994-7690
Mailing Address - Street 1:28175 HAGGERTY ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-2903
Mailing Address - Country:US
Mailing Address - Phone:248-994-7690
Mailing Address - Fax:248-994-7691
Practice Address - Street 1:28175 HAGGERTY ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-2903
Practice Address - Country:US
Practice Address - Phone:248-994-7690
Practice Address - Fax:248-994-7691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI006823103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6U4687Medicare UPIN