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General NPI Number Information
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NPI Number | 1467492173
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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 | 06/08/2006
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Last Update Date | 07/01/2025
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Provider Practice Location Address
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Address Line | 1715 INDIAN WOOD CIR STE 200
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City | MAUMEE
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State | OH
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Zip | 43537-4055
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Country | US
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Telephone | 877-906-9699
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Fax |
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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 | 103TA0700X
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Taxonomy Name | Adult Development & Aging Psychologist
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License Number |
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License Number State |
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