Healthcare Provider Details

I. General information

NPI: 1790709764
Provider Name (Legal Business Name): DEIRDRE ANN CONROY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5777 W MAPLE RD STE 185
WEST BLOOMFIELD MI
48322-2268
US

IV. Provider business mailing address

397 E BRECKENRIDGE ST # 104
FERNDALE MI
48220-1321
US

V. Phone/Fax

Practice location:
  • Phone: 313-241-6067
  • Fax: 313-552-7926
Mailing address:
  • Phone: 734-223-7148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301012804
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number6301012804
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code173F00000X
TaxonomySleep Specialist (PhD)
License Number6301012804
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: