Healthcare Provider Details

I. General information

NPI: 1992180509
Provider Name (Legal Business Name): DANIEL DEWEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2015
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15001 KERCHEVAL AVE UNIT 174
GROSSE POINTE PARK MI
48230-1361
US

IV. Provider business mailing address

15001 KERCHEVAL AVE UNIT 174
GROSSE POINTE PARK MI
48230-1361
US

V. Phone/Fax

Practice location:
  • Phone: 313-217-3660
  • Fax:
Mailing address:
  • Phone: 313-217-3660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301019943
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: