Healthcare Provider Details

I. General information

NPI: 1962752436
Provider Name (Legal Business Name): REGENTS OF THE UNIVERSITY OF MICHIGAN CENTER FOR THE CHILD AND FAMILY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2012
Last Update Date: 09/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 CHURCH ST SUITE 1465
ANN ARBOR MI
48109-1043
US

IV. Provider business mailing address

530 CHURCH ST SUITE 1465
ANN ARBOR MI
48109-1043
US

V. Phone/Fax

Practice location:
  • Phone: 734-764-9466
  • Fax: 734-647-1051
Mailing address:
  • Phone: 734-764-9466
  • Fax: 734-647-1051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. CYNTHIA EWELL FOSTER
Title or Position: DIRECTOR
Credential: PH.D.
Phone: 734-764-9466