Healthcare Provider Details

I. General information

NPI: 1174925630
Provider Name (Legal Business Name): NIDA HAMID PSYD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 06/08/2020
Certification Date: 06/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3155 W BIG BEAVER RD STE 109
TROY MI
48084-3006
US

IV. Provider business mailing address

3155 W BIG BEAVER RD STE 109
TROY MI
48084-3006
US

V. Phone/Fax

Practice location:
  • Phone: 248-878-0925
  • Fax: 248-644-0237
Mailing address:
  • Phone: 248-385-5756
  • Fax: 248-385-5758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301014942
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number6301014942
License Number StateMI

VIII. Authorized Official

Name: DR. NIDA H HAMID
Title or Position: OWNER/PRESIDENT
Credential: PSY.D.
Phone: 248-385-5756