Provider Demographics
NPI:1386754117
Name:MAH, GERDA T (MA LLP)
Entity type:Individual
Prefix:MS
First Name:GERDA
Middle Name:T
Last Name:MAH
Suffix:
Gender:F
Credentials:MA LLP
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2958 ORBIT DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48360-1976
Mailing Address - Country:US
Mailing Address - Phone:248-391-2043
Mailing Address - Fax:248-391-0890
Practice Address - Street 1:888 W BIG BEAVER RD
Practice Address - Street 2:1450
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4736
Practice Address - Country:US
Practice Address - Phone:248-244-8644
Practice Address - Fax:248-244-1330
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI6301000810103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical