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General NPI Number Information
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NPI Number | 1861734923
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Entity Type | Individual
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Provider Name | DIANE L. OLDENBURG-DURECKA M.A., LLP
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Gender | Female
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Dates
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Enumeration Date | 03/26/2013
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 29260 FRANKLIN RD STE 110
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1196
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Country | US
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Telephone | 248-798-1146
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Fax |
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Provider Business Mailing Address
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Address Line | 5210 VAN NESS DR
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48302-2664
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Country | US
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Telephone | 248-798-1146
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6361006477
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6361006477
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License Number State | MI
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