Provider Demographics
NPI:1396918199
Name:AFFILIATED PSYCHOLOGISTS OF MICHIGAN, P.C.
Entity type:Organization
Organization Name:AFFILIATED PSYCHOLOGISTS OF MICHIGAN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:PIETROFESA
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:248-642-6066
Mailing Address - Street 1:74 W LONG LAKE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-2769
Mailing Address - Country:US
Mailing Address - Phone:248-642-6066
Mailing Address - Fax:248-642-5739
Practice Address - Street 1:74 W LONG LAKE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-2769
Practice Address - Country:US
Practice Address - Phone:248-642-6066
Practice Address - Fax:248-642-5739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-12
Last Update Date:2008-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty