Healthcare Provider Details

I. General information

NPI: 1649782244
Provider Name (Legal Business Name): MATTHEW KADRICH PSY.D., LP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2017
Last Update Date: 11/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3334 ROCHESTER RD # 205
TROY MI
48083-5426
US

IV. Provider business mailing address

3334 ROCHESTER RD # 205
TROY MI
48083-5426
US

V. Phone/Fax

Practice location:
  • Phone: 843-450-8611
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301016806
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: