MEDICARE: DR. CAROLYN DAITCH 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	6301002465	MI

General Provider Information

NPI Number	:	1992963607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROLYN DAITCH PH.D.

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2008
Last Update Date	:	05/29/2008

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Directions to “ DR. CAROLYN DAITCH PH.D.” Practice Location

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