MEDICARE: MRS. JUDY ANNETTE HART-BERMEA T.L.L.P.

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	103T00000X	Psychologist	6301013755	MI

General Provider Information

NPI Number	:	1609002625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JUDY ANNETTE HART-BERMEA T.L.L.P.

Provider Business Mailing Address
First Line	:	3815 W FORT ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48216-1652
Country	:	US
Telephone Number	:	313-841-7380
Fax Number	:	313-841-3730

Provider Business Practice Location Address
First Line	:	3815 W FORT ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48216-1652
Country	:	US
Telephone Number	:	313-841-7380
Fax Number	:	313-841-3730

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

Provider Enumeration Date	:	06/04/2009
Last Update Date	:	06/04/2009

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Directions to “ MRS. JUDY ANNETTE HART-BERMEA T.L.L.P.” Practice Location

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