Healthcare Provider Details

I. General information

NPI: 1568679470
Provider Name (Legal Business Name): DENNIS P SUGRUE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 E HUDSON AVE # 1115
ROYAL OAK MI
48067-3711
US

IV. Provider business mailing address

313 E HUDSON AVE # 1115
ROYAL OAK MI
48067-3711
US

V. Phone/Fax

Practice location:
  • Phone: 248-888-8390
  • Fax: 413-740-5624
Mailing address:
  • Phone: 248-888-8390
  • Fax: 413-740-5624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301003771
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: