Healthcare Provider Details

I. General information

NPI: 1922025584
Provider Name (Legal Business Name): CAROL ANN SYPERSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 WALNUT BLVD PAINT CREEK PSYCHOLOGISTS
ROCHESTER MI
48307-2086
US

IV. Provider business mailing address

330 E MAPLE RD #218
BIRMINGHAM MI
48009-6313
US

V. Phone/Fax

Practice location:
  • Phone: 248-885-1488
  • Fax:
Mailing address:
  • Phone: 248-885-1488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401008680
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number56
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: