Healthcare Provider Details

I. General information

NPI: 1023330776
Provider Name (Legal Business Name): JOCELYN DIANE MCCRAE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2010
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 BEAUBIEN ST # 3257
DETROIT MI
48201-2119
US

IV. Provider business mailing address

PO BOX 673671
DETROIT MI
48267-3671
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-8214
  • Fax: 313-745-3211
Mailing address:
  • Phone: 810-720-5715
  • Fax: 810-732-0891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301008854
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: