| Mitchell S. Weisbrod, Psy.d., Pllc | |
|
115 S West Ave Ste 1 Jackson MI 49201-2085 | |
| (517) 544-7700 | |
| (517) 612-8817 |
| Full Name | Mitchell S. Weisbrod, Psy.d., Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 115 S West Ave Ste 1, Jackson, Michigan |
| Authorized Official Name and Position | Mitchell Scott Weisbrod (CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 5175447700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mitchell S. Weisbrod, Psy.d., Pllc 115 S West Ave Ste 1 Jackson MI 49201-2085 Ph: (517) 544-7700 | Mitchell S. Weisbrod, Psy.d., Pllc 115 S West Ave Ste 1 Jackson MI 49201-2085 Ph: (517) 544-7700 |
| NPI Number | 1760752976 |
|---|---|
| Provider Enumeration Date | 01/04/2012 |
| Last Update Date | 04/07/2017 |
| Medicare PECOS PAC ID | 3779744388 |
|---|---|
| Medicare Enrollment ID | O20120409000094 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760752976 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 6301008984 (Michigan) | Primary |
| Provider Name | Mitchell S Weisbrod |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1629141007 PECOS PAC ID: 7911087523 Enrollment ID: I20080109000199 |
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