Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 6301011301 | MI |
Y | 103G00000X | Clinical Psychologist | 6301011301 | MI |
Y | 103TC0700X | Clinical Psychologist | 6301011301 | MI |
NPI | 1194909093 |
---|---|
Provider Name | Bonita M Pedrosi |
First Address | Ferndale, MI 48220-3302 |
Second Address | Ferndale, MI 48220-3302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2007 |
Last Update Date | 27/12/2007 |