Healthcare Provider Details

I. General information

NPI: 1730243262
Provider Name (Legal Business Name): CHARLES R STERN PC INTERVISIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20811 KELLY
EASTPOINTE MI
48021
US

IV. Provider business mailing address

1839 SHIPMAN
BIRMINGHAM MI
48009
US

V. Phone/Fax

Practice location:
  • Phone: 586-445-3612
  • Fax: 586-445-0700
Mailing address:
  • Phone: 586-445-3612
  • Fax: 586-445-0700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301005261
License Number StateMI

VIII. Authorized Official

Name: DR. CHARLES RAYMOND STERN
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 586-445-3612