| Cognitive Care Center Pc | |
|
43155 Main St Atrium 2300 Suite O Novi MI 48375-1777 | |
| (248) 330-7281 | |
| Not Available |
| Full Name | Cognitive Care Center Pc |
|---|---|
| Speciality | Psychologist |
| Location | 43155 Main St, Novi, Michigan |
| Authorized Official Name and Position | Juvaria Javaid (MSLLP) |
| Authorized Official Contact | 2483307281 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cognitive Care Center Pc 43155 Main St Atrium 2300 Suite O Novi MI 48375-1777 Ph: () - | Cognitive Care Center Pc 43155 Main St Atrium 2300 Suite O Novi MI 48375-1777 Ph: (248) 330-7281 |
| NPI Number | 1649664467 |
|---|---|
| Provider Enumeration Date | 03/19/2015 |
| Last Update Date | 03/19/2015 |
| Medicare PECOS PAC ID | 5890014898 |
|---|---|
| Medicare Enrollment ID | O20150424000249 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649664467 | NPI | - | NPPES |
| 6301013794 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 6301013794 (Michigan) | Primary |
| Provider Name | Constance C Gwynn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144488024 PECOS PAC ID: 5496821639 Enrollment ID: I20080911000543 |
| Provider Name | Juvaria Javaid |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1851673537 PECOS PAC ID: 8224353669 Enrollment ID: I20150206000724 |
| Provider Name | James Wickersham |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1396106225 PECOS PAC ID: 1456635663 Enrollment ID: I20170308001067 |
| Provider Name | Aliah F Azmeh |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356874671 PECOS PAC ID: 3476827312 Enrollment ID: I20170915002774 |
| Provider Name | Michelle R Kehrmeyer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033636188 PECOS PAC ID: 2769749126 Enrollment ID: I20171120003803 |
| Provider Name | Angela Lucas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760844922 PECOS PAC ID: 8022364736 Enrollment ID: I20180711002119 |
| Provider Name | Alexis N Lykins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154982346 PECOS PAC ID: 6507193612 Enrollment ID: I20210316002041 |
| Provider Name | Michele E Lloyd |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457803108 PECOS PAC ID: 3678970456 Enrollment ID: I20210921002421 |
| Provider Name | Saara Patel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114325495 PECOS PAC ID: 5395126908 Enrollment ID: I20220713003624 |
| Provider Name | Farida Mujtaba |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528458189 PECOS PAC ID: 8325403868 Enrollment ID: I20230505000198 |
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