Healthcare Provider Details

I. General information

NPI: 1124139480
Provider Name (Legal Business Name): ANTHONY RANIERO DE ORIO LLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41820 6 MILE RD
NORTHVILLE MI
48168-2763
US

IV. Provider business mailing address

41820 6 MILE RD
NORTHVILLE MI
48168-2763
US

V. Phone/Fax

Practice location:
  • Phone: 248-349-3131
  • Fax: 248-349-3232
Mailing address:
  • Phone: 248-349-3131
  • Fax: 248-349-3232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301011207
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: