Healthcare Provider Details

I. General information

NPI: 1528387818
Provider Name (Legal Business Name): SARAH E BARNUM PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH E CROSSETT

II. Dates (important events)

Enumeration Date: 05/26/2010
Last Update Date: 10/23/2020
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30503 GREENFIELD RD BEAUMONT CENTER FOR HUMAN DEVELOPMENT
SOUTHFIELD MI
48076-1594
US

IV. Provider business mailing address

26901 BEAUMONT BLVD STE 3D
SOUTHFIELD MI
48033-3849
US

V. Phone/Fax

Practice location:
  • Phone: 248-691-4744
  • Fax: 248-691-4745
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301016863
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: