Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 6301014167 | MI |
Y | 103T00000X | Psychologist | 6301014167 | MI |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 6301014167 | MI |
N | 103G00000X | Clinical Psychologist | 6301014167 | MI |
N | 103TC0700X | Clinical Psychologist | 6301014167 | MI |
N | 103TM1800X | Intellectual & Developmental Disabilities | 6301014167 | MI |
NPI | 1114352606 |
---|---|
Provider Name | Dr. Paolo Todesco |
First Address | Groose Pointe Woods, MI 48236 |
Second Address | Groose Pointe Woods, MI 48236 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2013 |
Last Update Date | 04/09/2013 |