Healthcare Provider Details

I. General information

NPI: 1356391304
Provider Name (Legal Business Name): DARLENE ANN SWIDERSKI PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27427 SCHOENHERR RD SUITE 200
WARREN MI
48088-4729
US

IV. Provider business mailing address

20290 DRUMMOND BAY
CLINTON TOWNSHIP MI
48038-1467
US

V. Phone/Fax

Practice location:
  • Phone: 586-773-1900
  • Fax:
Mailing address:
  • Phone: 586-773-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number6301003399
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301003399
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number6301003399
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301003399
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: