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General NPI Number Information
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NPI Number | 1730243262
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Entity Type | Organization
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Legal Business Name | CHARLES R STERN PC INTERVISIONS
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 03/05/2008
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Provider Practice Location Address
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Address Line | 20811 KELLY
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City | EASTPOINTE
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State | MI
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Zip | 48021
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Country | US
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Telephone | 586-445-3612
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Fax | 586-445-0700
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Provider Business Mailing Address
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Address Line | 1839 SHIPMAN
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City | BIRMINGHAM
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State | MI
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Zip | 48009
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Country | US
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Telephone | 586-445-3612
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Fax | 586-445-0700
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. CHARLES RAYMOND STERN
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Credential | PHD
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Telephone | 586-445-3612
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301005261
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License Number State | MI
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