MEDICARE: DR. LENA AGREE PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	6301016065	MI

General Provider Information

NPI Number	:	1336420009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LENA AGREE PSYD

Provider Business Mailing Address
First Line	:	4479 STRATHDALE LN
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48323-2854
Country	:	US
Telephone Number	:	248-219-2548
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 MARTIN ST # 100
Second Line	:
City	:	BIRMINGHAM
State	:	MI
Zip	:	48009-3352
Country	:	US
Telephone Number	:	248-219-2548
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2011
Last Update Date	:	02/28/2019

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