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General NPI Number Information
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NPI Number | 1063908572
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Entity Type | Organization
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Legal Business Name | COLLEEN BERTANI PC
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Dates
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Enumeration Date | 07/09/2018
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Last Update Date | 07/09/2018
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Provider Practice Location Address
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Address Line | 8906 COMMERCE RD STE 1
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City | COMMERCE TWP
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State | MI
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Zip | 48382-4484
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Country | US
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Telephone | 248-325-8632
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Fax |
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Provider Business Mailing Address
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Address Line | 11215 LAKEHAVEN DR
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City | WHITE LAKE
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State | MI
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Zip | 48386-3647
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Country | US
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Telephone | 248-921-3433
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | COLLEEN BERTANI
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Credential | LMSW, CAADC
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Telephone | 248-921-3433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 6801080362
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License Number State | MI
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