Healthcare Provider Details

I. General information

NPI: 1467233262
Provider Name (Legal Business Name): SAREEN SOBH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23924 MICHIGAN AVE
DEARBORN MI
48124-1833
US

IV. Provider business mailing address

22345 WILSON AVE
DEARBORN MI
48128-1844
US

V. Phone/Fax

Practice location:
  • Phone: 313-300-4337
  • Fax:
Mailing address:
  • Phone: 313-300-4337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6362010256
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number6362010256
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number6362010256
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6362010256
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: