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NPI Code Detail

MEDICARE: MS. SUSAN ELLEN BINDER-DEMOTT MA, LLP

MEDICARE: MS. SUSAN ELLEN BINDER-DEMOTT MA, LLP
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
1103T00000XPsychologist6301009039MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1730234410
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SUSAN ELLEN BINDER-DEMOTT MA, LLP
Provider Business Mailing Address
First Line : 79 W ALEXANDRINE ST
Second Line :
City : DETROIT
State : MI
Zip : 48201-2015
Country : US
Telephone Number : 313-831-5535
Fax Number : 313-831-2608
Provider Business Practice Location Address
First Line : 79 W. ALEXANDRINE STREET
Second Line :
City : DETROIT
State : MI
Zip : 48201-2015
Country : US
Telephone Number : 313-831-5535
Fax Number : 313-831-2608
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2007
Last Update Date : 11/15/2012

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