Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | ||
N | 103T00000X | Psychologist | ||
N | 103TC1900X | Counseling Psychologist |
NPI | 1013129303 |
---|---|
Provider Name | Mariane Loeckner |
First Address | Detroit, MI 48202-3450 |
Second Address | Detroit, MI 48202-3450 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 08/07/2007 |