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General NPI Number Information
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NPI Number | 1104063239
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Entity Type | Organization
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Legal Business Name | GERIATRIC PSYCHIATRIC SERVICES PLLC
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Dates
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Enumeration Date | 01/12/2009
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Last Update Date | 07/25/2024
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Provider Practice Location Address
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Address Line | 28800 RYAN RD SUITE 320
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City | WARREN
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State | MI
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Zip | 48092-4272
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Country | US
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Telephone | 586-620-8100
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Fax | 866-227-7418
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Provider Business Mailing Address
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Address Line | 39465 W 14 MILE RD
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City | NOVI
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State | MI
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Zip | 48377-1600
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Country | US
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Telephone | 248-859-3900
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Fax | 888-483-0118
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Authorized Official
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Title or Position | MANAGER
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Name | ROBERT A CLEMENTE
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Credential |
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Telephone | 586-620-8100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 364SA2200X
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Taxonomy Name | Adult Health Clinical Nurse Specialist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 364SP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Clinical Nurse Specialist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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