Provider Demographics
NPI:1326896382
Name:PAGE, SYDNEY MAZIE
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:MAZIE
Last Name:PAGE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:SYDNEY
Other - Middle Name:MAZIE
Other - Last Name:PILUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4700 SCHAEFER RD STE 340
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3743
Mailing Address - Country:US
Mailing Address - Phone:313-561-5100
Mailing Address - Fax:
Practice Address - Street 1:2700 HAMLIN BLVD
Practice Address - Street 2:
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141-2206
Practice Address - Country:US
Practice Address - Phone:313-561-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-07
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health