Provider Demographics
NPI:1962437939
Name:BEN-AMI PSYCHIATRY AND PSYCHOTHERAPY
Entity type:Organization
Organization Name:BEN-AMI PSYCHIATRY AND PSYCHOTHERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DORIT
Authorized Official - Middle Name:A
Authorized Official - Last Name:BEN-AMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-514-4349
Mailing Address - Street 1:28270 TAVISTOCK TRL
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-5181
Mailing Address - Country:US
Mailing Address - Phone:248-514-4349
Mailing Address - Fax:
Practice Address - Street 1:28270 TAVISTOCK TRL
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-5181
Practice Address - Country:US
Practice Address - Phone:248-514-4349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010805082084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F35547OtherBCBS
MI0F35547OtherBCBS