1144769050 NPI number — CAROL DIANE PSAILA

Table of content: (NPI 1144769050)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144769050 NPI number — CAROL DIANE PSAILA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROL DIANE PSAILA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144769050
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7618 BAY TREE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YPSILANTI
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48197-9572
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-358-3810
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3830 PACKARD ST STE 250
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANN ARBOR
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48108-2273
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-358-3810
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/13/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PSAILA
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
D
Authorized Official Title or Position:
LMSW
Authorized Official Telephone Number:
734-358-3810

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  6801077434 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)