NPIMap

Organization Active NPI

Birmingham Maple Clinic

  • Clinical Psychologist
  • Troy, MI
National Provider Identifier
1144524133
Registry record updated Apr 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
BIRMINGHAM MAPLE CLINIC
Practice address
2075 W Big Beaver Rd
Suite 520
Troy, MI 48084-3407
Phone
(248) 646-6659
Fax
(248) 642-8645
NPI assigned
Jan 5, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Lori Kanat Edelson, LMSWNPI 1407994924
Title
Business Owner
Phone
(248) 646-6659

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TC0700X Primary
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X

Addresses

Primary practice location

2075 W Big Beaver Rd
Suite 520
Troy, MI 48084-3407

Mailing address

2075 W Big Beaver Rd
Suite 520
Troy, MI 48084-3407
Phone (248) 646-6659

National Provider Directory

National Provider Directory
Tax ID family
Birmingham Maple Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1294185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366243200000",
    "number": "1144524133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2075 W BIG BEAVER RD",
            "address_2": "SUITE 520",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480843407",
            "telephone_number": "248-646-6659",
            "fax_number": "248-642-8645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2075 W BIG BEAVER RD",
            "address_2": "SUITE 520",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480843407",
            "telephone_number": "248-646-6659",
            "fax_number": "248-642-8645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BIRMINGHAM MAPLE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-05",
        "last_updated": "2013-04-18",
        "status": "A",
        "authorized_official_last_name": "EDELSON",
        "authorized_official_first_name": "LORI",
        "authorized_official_middle_name": "KANAT",
        "authorized_official_title_or_position": "BUSINESS OWNER",
        "authorized_official_telephone_number": "248-646-6659",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LMSW"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Troy, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.