Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 1-00252 | MI |
N | 103TP2701X | Group Psychotherapist | 6301002903 | MI |
NPI | 1497812523 |
---|---|
Provider Name | Melvin Hoberman I |
First Address | W Bloomfield, MI 48322-2290 |
Second Address | W Bloomfield, MI 48322-2290 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/01/2007 |
Last Update Date | 18/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6801011116 | LICENSE NO. (01) | MI |
OP25740 | (02) | MI |