Basic Information
| Provider Information | |||||||||
| NPI: | 1720163355 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRDAK | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | EYMAN | ||||||||
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| Credential: | MA, LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16952 KENSINGTON DR | ||||||||
| Address2: | |||||||||
| City: | MACOMB | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480444093 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483020998 | ||||||||
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| Practice Location | |||||||||
| Address1: | 22170 W 9 MILE RD | ||||||||
| Address2: | |||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480336007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483726800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2006 | ||||||||
| LastUpdateDate: | 09/04/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 6301012402 | MI | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.