NPIMap

Organization Active NPI

Affiliated Psychologists of Michigan, P.C.

  • Psychologist
  • Bloomfield Hills, MI
National Provider Identifier
1396918199
Registry record updated Apr 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
AFFILIATED PSYCHOLOGISTS OF MICHIGAN, P.C.
Practice address
74 W Long Lake Rd
Suite 104
Bloomfield Hills, MI 48304-2769
Phone
(248) 642-6066
Fax
(248) 642-5739
NPI assigned
Apr 12, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2008

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

Authorized official

Name
John P Pietrofesa, ED.D.
Title
President
Phone
(248) 642-6066

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X Primary

Addresses

Primary practice location

74 W Long Lake Rd
Suite 104
Bloomfield Hills, MI 48304-2769

Mailing address

74 W Long Lake Rd
Suite 104
Bloomfield Hills, MI 48304-2769
Phone (248) 642-6066

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110421000024 MI Part B Supplier - Clinic/Group Practice 8426233248 Receives reassigned benefits from 2 practitioners
Practice locations: Bloomfield Hills, MI

National Provider Directory

National Provider Directory

Locations

74 W Long Lake Rd
Ste 104
Bloomfield Hills, MI 48304
Phone (248) 642-6066

74 W Long Lake Rd
Ste 201
Bloomfield Hills, MI 48304
Phone (248) 642-6066

Practitioners & affiliated clinicians

Practitioners 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1207958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207958400000",
    "number": "1396918199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "74 W LONG LAKE RD",
            "address_2": "SUITE 104",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483042769",
            "telephone_number": "248-642-6066",
            "fax_number": "248-642-5739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "74 W LONG LAKE RD",
            "address_2": "SUITE 104",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483042769",
            "telephone_number": "248-642-6066",
            "fax_number": "248-642-5739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AFFILIATED PSYCHOLOGISTS OF MICHIGAN, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-12",
        "last_updated": "2008-04-12",
        "status": "A",
        "authorized_official_last_name": "PIETROFESA",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "248-642-6066",
        "authorized_official_credential": "ED.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomfield Hills, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.