Healthcare Provider Details

I. General information

NPI: 1831993450
Provider Name (Legal Business Name): MARY J BELONGEA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2025
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

657 WATERSEDGE DR
ANN ARBOR MI
48105-2514
US

IV. Provider business mailing address

657 WATERSEDGE DR
ANN ARBOR MI
48105-2514
US

V. Phone/Fax

Practice location:
  • Phone: 734-417-8438
  • Fax:
Mailing address:
  • Phone: 734-417-8438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MARY J BELONGEA
Title or Position: LIMITED LICENSE PSYCHOLOGIST
Credential: LIMITED LICENSE PSYC
Phone: 734-417-8438