Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 6301001417 | MI |
Y | 103TC0700X | Clinical Psychologist | 6301001417 | MI |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 6301001417 | MI |
N | 103TA0700X | Adult Development & Aging Psychologist | 6301001417 | MI |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 6301001417 | MI |
N | 103G00000X | Clinical Psychologist | 6301001417 | MI |
N | 103TC0700X | Clinical Psychologist | 6301001417 | MI |
N | 103TC1900X | Counseling Psychologist | 6301001417 | MI |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 6301001417 | MI |
N | 103TF0000X | Family Psychologist | 6301001417 | MI |
N | 103TF0200X | Forensic Psychologist | 6301001417 | MI |
N | 103TM1800X | Intellectual & Developmental Disabilities | 6301001417 | MI |
N | 103TP2701X | Group Psychotherapist | 6301001417 | MI |
N | 103TS0200X | School Psychologist | 6301001417 | MI |
NPI | 1306999628 |
---|---|
Provider Name | Dr. Judith A Bean |
First Address | Bloomfield Hills, MI 48302-2522 |
Second Address | Dearborn Heights, MI 48127-3182 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2007 |
Last Update Date | 25/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R81188 | (02) |