| Ottenbreit Psychotherapy Associates, Llc | |
|
835 Mason St B-200 Dearborn MI 48124-2231 | |
| (313) 575-6297 | |
| (313) 406-4617 |
| Full Name | Ottenbreit Psychotherapy Associates, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 835 Mason St, Dearborn, Michigan |
| Authorized Official Name and Position | Bruce D. Ottenbreit (CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 3135756297 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ottenbreit Psychotherapy Associates, Llc 835 Mason St B-200 Dearborn MI 48124-2231 Ph: (313) 575-6297 | Ottenbreit Psychotherapy Associates, Llc 835 Mason St B-200 Dearborn MI 48124-2231 Ph: (313) 575-6297 |
| NPI Number | 1639621857 |
|---|---|
| Provider Enumeration Date | 11/04/2016 |
| Last Update Date | 12/05/2016 |
| Medicare PECOS PAC ID | 3779863568 |
|---|---|
| Medicare Enrollment ID | O20161214000207 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639621857 | NPI | - | NPPES |
| 12313056 | Other | QAQH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | MSW-6801007603 (Michigan) | Primary |
| Provider Name | Bruce D Ottenbreit |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912215443 PECOS PAC ID: 1254582133 Enrollment ID: I20121128000702 |
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