Healthcare Provider Details

I. General information

NPI: 1427245711
Provider Name (Legal Business Name): ELLEN FAYE BLAU SR. PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 10/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33045 HAMILTON CT SUITE W-300
FARMINGTON HILLS MI
48334-3385
US

IV. Provider business mailing address

33045 HAMILTON CT SUITE W-300
FARMINGTON HILLS MI
48334-3385
US

V. Phone/Fax

Practice location:
  • Phone: 248-848-1558
  • Fax: 248-848-3592
Mailing address:
  • Phone: 248-848-1558
  • Fax: 248-848-3592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number011450
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: