Provider Demographics
NPI:1992879142
Name:PEREIRA, ROBERT (PHD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:PEREIRA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S ADAMS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-7018
Mailing Address - Country:US
Mailing Address - Phone:248-258-5064
Mailing Address - Fax:
Practice Address - Street 1:801 S ADAMS RD STE 200
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-7018
Practice Address - Country:US
Practice Address - Phone:248-258-5064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRP005866103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F34960Medicare ID - Type Unspecified
MIR67287Medicare UPIN