MEDICARE: DR. BETTE DIANE GLICKFIELD PH.D.

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	6301005241	MI

General Provider Information

NPI Number	:	1922079284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BETTE DIANE GLICKFIELD PH.D.

Provider Business Mailing Address
First Line	:	5600 W MAPLE RD
Second Line	:	SUITE D407
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3704
Country	:	US
Telephone Number	:	248-865-0938
Fax Number	:

Provider Business Practice Location Address
First Line	:	5600 W MAPLE RD
Second Line	:	SUITE D407
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3704
Country	:	US
Telephone Number	:	248-865-0938
Fax Number	:

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

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	07/08/2007

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