Healthcare Provider Details

I. General information

NPI: 1154012995
Provider Name (Legal Business Name): KRISTIN CASTELVETERE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTIN MARIE AHO

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 PLYMOUTH RD
ANN ARBOR MI
48109-2700
US

IV. Provider business mailing address

3621 S STATE ST
ANN ARBOR MI
48108-1633
US

V. Phone/Fax

Practice location:
  • Phone: 734-764-0231
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number6301019881
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: