Healthcare Provider Details

I. General information

NPI: 1508045865
Provider Name (Legal Business Name): JANEEN NOELLA DUBEY LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 11/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 N CLARE AVE
HARRISON MI
48625-9194
US

IV. Provider business mailing address

789 N CLARE AVE
HARRISON MI
48625-9194
US

V. Phone/Fax

Practice location:
  • Phone: 989-539-2124
  • Fax: 989-539-2143
Mailing address:
  • Phone: 989-539-2124
  • Fax: 989-539-2143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301012510
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: