Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 6301013287 | MI |
NPI | 1023413853 |
---|---|
Provider Name | Dr. Cristovao Bartolo Carreira |
First Address | Grosse Pointe, MI 48230 |
Second Address | Grosse Pointe, MI 48230 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2014 |
Last Update Date | 22/10/2014 |