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NPI Code Detail

MEDICARE: DR. JUDY MARIE SOBCZAK PHD

MEDICARE: DR. JUDY MARIE SOBCZAK PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist006823MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1056854OTHERVALUE OPTIONS

General Provider Information

NPI Number : 1871502393
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JUDY MARIE SOBCZAK PHD
Provider Business Mailing Address
First Line : 28175 HAGGERTY RD
Second Line : SUITE 101
City : NOVI
State : MI
Zip : 48377-2903
Country : US
Telephone Number : 248-994-7690
Fax Number : 248-994-7691
Provider Business Practice Location Address
First Line : 28175 HAGGERTY RD
Second Line : SUITE 101
City : NOVI
State : MI
Zip : 48377-2903
Country : US
Telephone Number : 248-994-7690
Fax Number : 248-994-7691
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/05/2006
Last Update Date : 01/25/2008

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