MEDICARE: CENTER FOR THE TREATMENT OF ANXIETY DISORDERS

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	6301002465	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	680F327570	OTHER	MI	BCBS PIN #

General Provider Information

NPI Number	:	1710008990
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR THE TREATMENT OF ANXIETY DISORDERS

Provider Business Mailing Address
First Line	:	28592 ORCHARD LAKE RD
Second Line	:	#301
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-2961
Country	:	US
Telephone Number	:	248-626-8151
Fax Number	:	248-626-7277

Provider Business Practice Location Address
First Line	:	28592 ORCHARD LAKE RD
Second Line	:	#301
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-2961
Country	:	US
Telephone Number	:	248-626-8151
Fax Number	:	248-626-7277

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. CAROLYN DAITCH
Credential	:	PH.D.
Telephone Number	:	248-626-8151

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	06/24/2008

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Directions to “CENTER FOR THE TREATMENT OF ANXIETY DISORDERS ” Practice Location

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