Healthcare Provider Details

I. General information

NPI: 1821327222
Provider Name (Legal Business Name): AMY J. TRABITZ, PH.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2009
Last Update Date: 10/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23810 MICHIGAN AVE SUITE 202B
DEARBORN MI
48124-1830
US

IV. Provider business mailing address

23810 MICHIGAN AVE SUITE 202B
DEARBORN MI
48124-1830
US

V. Phone/Fax

Practice location:
  • Phone: 313-359-3161
  • Fax: 313-359-4811
Mailing address:
  • Phone: 313-359-3161
  • Fax: 313-359-4811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number6301006103
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number6301006103
License Number StateMI

VIII. Authorized Official

Name: DR. AMY J. TRABITZ
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 313-359-3161