| Birmingham Maple Clinic | |
|
2075 W Big Beaver Rd Suite 520 Troy MI 48084-3407 | |
| (248) 646-6659 | |
| (248) 642-8645 |
| Full Name | Birmingham Maple Clinic |
|---|---|
| Speciality | Counselor |
| Location | 2075 W Big Beaver Rd, Troy, Michigan |
| Authorized Official Name and Position | Perri Hope Rosen (OFFICE MANAGER) |
| Authorized Official Contact | 2486466659 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Birmingham Maple Clinic 2075 Big Beaver Rd Suite 520 Troy MI 48084 Ph: (248) 646-6659 | Birmingham Maple Clinic 2075 W Big Beaver Rd Suite 520 Troy MI 48084-3407 Ph: (248) 646-6659 |
| NPI Number | 1558412551 |
|---|---|
| Provider Enumeration Date | 01/16/2007 |
| Last Update Date | 07/16/2015 |
| Medicare PECOS PAC ID | 6800867755 |
|---|---|
| Medicare Enrollment ID | O20040804000201 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558412551 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Primary |
| Provider Name | Sharon R Harkins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548308166 PECOS PAC ID: 0143307611 Enrollment ID: I20080408000495 |
| Provider Name | Dina B Berdy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760685291 PECOS PAC ID: 2062578438 Enrollment ID: I20090310000364 |
| Provider Name | Caren Landau |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205059276 PECOS PAC ID: 9032248455 Enrollment ID: I20100524000569 |
| Provider Name | Lori K Edelson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407994924 PECOS PAC ID: 5395717466 Enrollment ID: I20100616000596 |
| Provider Name | Linda S Supple-diaz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518080282 PECOS PAC ID: 1557491537 Enrollment ID: I20100618000054 |
| Provider Name | Ariella T Kaufman Rubin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497193908 PECOS PAC ID: 2668615352 Enrollment ID: I20130828000309 |
| Provider Name | Abigail Kercorian |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427497544 PECOS PAC ID: 2466676341 Enrollment ID: I20140616001381 |
| Provider Name | Julian R Diaz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447501648 PECOS PAC ID: 7911205430 Enrollment ID: I20160418001395 |
| Provider Name | Jennifer A Gramzow |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1346381795 PECOS PAC ID: 2860787785 Enrollment ID: I20160817000438 |
| Provider Name | Geoffrey John Kantack |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053718759 PECOS PAC ID: 3971899923 Enrollment ID: I20160831001286 |
| Provider Name | Dominic C Moceri |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1346625225 PECOS PAC ID: 3779853718 Enrollment ID: I20170724002603 |
| Provider Name | Abra E Kitei |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043385297 PECOS PAC ID: 8729319132 Enrollment ID: I20191016003252 |
| Provider Name | Brittany I Webb |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225378219 PECOS PAC ID: 7315351954 Enrollment ID: I20210122000850 |
| Provider Name | Erinn Kohn |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1770123564 PECOS PAC ID: 1153757729 Enrollment ID: I20230413000161 |
| Provider Name | Jennifer D Hanawalt |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1386999472 PECOS PAC ID: 6608222567 Enrollment ID: I20231028000306 |
| Provider Name | Ronald Hormel |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1003173113 PECOS PAC ID: 8224471255 Enrollment ID: I20240207000934 |
| Provider Name | Paula Jorne |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1326133414 PECOS PAC ID: 7719875038 Enrollment ID: I20240223002437 |
| Provider Name | Kelley Watson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1184863920 PECOS PAC ID: 7113366451 Enrollment ID: I20240418003099 |
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