Basic Information
| Provider Information | |||||||||
| NPI: | 1609540657 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BIRNBAUM | ||||||||
| FirstName: | RICHARD | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1540 EAST MEDICAL CENTER DRIVE | ||||||||
| Address2: | LEVEL 5 | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481095318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349364220 | ||||||||
| FaxNumber: | 7349366897 | ||||||||
| Practice Location | |||||||||
| Address1: | 1540 EAST MEDICAL CENTER DRIVE | ||||||||
| Address2: | LEVEL 5 | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481095318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349364220 | ||||||||
| FaxNumber: | 7349366897 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2021 | ||||||||
| LastUpdateDate: | 08/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 6301018877 | MI | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.