| Carissa Gaden, Ph.d., P.c. | |
|
27941 Harper Ave Ste 102 Saint Clair Shores MI 48081-1535 | |
| (586) 772-9390 | |
| (586) 859-5300 |
| Full Name | Carissa Gaden, Ph.d., P.c. |
|---|---|
| Speciality | Psychologist |
| Location | 27941 Harper Ave Ste 102, Saint Clair Shores, Michigan |
| Authorized Official Name and Position | Carissa Gaden (PRESIDENT) |
| Authorized Official Contact | 5867729390 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Carissa Gaden, Ph.d., P.c. 27941 Harper Ave Ste 102 Saint Clair Shores MI 48081-1535 Ph: (586) 772-9390 | Carissa Gaden, Ph.d., P.c. 27941 Harper Ave Ste 102 Saint Clair Shores MI 48081-1535 Ph: (586) 772-9390 |
| NPI Number | 1982820957 |
|---|---|
| Provider Enumeration Date | 04/18/2007 |
| Last Update Date | 11/08/2022 |
| Certification Date | 11/08/2022 |
| Medicare PECOS PAC ID | 8527951946 |
|---|---|
| Medicare Enrollment ID | O20040207000206 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982820957 | NPI | - | NPPES |
| 71020000EO1883 | Other | MI | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (Michigan) | Primary |
| Provider Name | Carissa L Gaden |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1306927603 PECOS PAC ID: 3971496399 Enrollment ID: I20040210000093 |
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