Active NPI
Kaela Dorman
- Psychologist
- Southgate, MI
National Provider Identifier
1255530234
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- Practice address
- 19401 Northline Rd
Southgate, MI 48195-2277 - Phone
- (734) 785-7718
- NPI assigned
- Jul 11, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | Primary |
Addresses
Primary practice location
19401 Northline Rd
Southgate, MI 48195-2277
Mailing address
19401 Northline Rd
Southgate, MI 48195-2277
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184112000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184112000000",
"number": "1255530234",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19401 NORTHLINE RD",
"city": "SOUTHGATE",
"state": "MI",
"postal_code": "481952277"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19401 NORTHLINE RD",
"city": "SOUTHGATE",
"state": "MI",
"postal_code": "481952277",
"telephone_number": "734-785-7718"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DORMAN",
"first_name": "KAELA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-07-11",
"last_updated": "2007-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southgate, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.