Healthcare Provider Details

I. General information

NPI: 1902404122
Provider Name (Legal Business Name): DORREAN RILEY LLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2020
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22150 W 9 MILE RD
SOUTHFIELD MI
48033-6007
US

IV. Provider business mailing address

22150 W 9 MILE RD
SOUTHFIELD MI
48033-6007
US

V. Phone/Fax

Practice location:
  • Phone: 248-372-6800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6361008075
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6361008075
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: