Dorothy Beatrice Jenkins, DOCTOR – Psychologist

Key facts

NPI: 1598089526
Entity type: Individual (NPI type 1)
Primary specialty: Psychologist 103T00000X
License: 2480017 (MI)
Practice address: 505 Beechwood St
River Rouge, MI 48218-1041
Phone: (313) 386-2288
Fax: (313) 386-5986
NPI assigned: Mar 19, 2010
Sex: Female
Sole proprietor: Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Exec-U-Tech Behavioral Therapy Community/Behavioral Health Agency · River Rouge, MI · NPI 1568776086

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
2480017	MI	MD	Psychologist
1984150	MI	MD	Clinical Social Worker
1984159	MI	MD	Marriage & Family Therapist

Practice roles

Organization	Specialty	Status	New patients
Exec-U-Tech Behavioral Therapy		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Psychologist	103T00000X	2480017	MI	Yes
Clinical Social Worker	1041C0700X	1984150	MI
Marriage & Family Therapist	106H00000X	1984159	MI

Addresses

Primary practice location

505 Beechwood St
River Rouge, MI 48218-1041

Mailing address

1109 Iroquois St
Detroit, MI 48214-2751
Phone (313) 598-6638

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 19, 2010.

{
    "created_epoch": "1268956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1268956800000",
    "number": "1598089526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1109 IROQUOIS ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482142751",
            "telephone_number": "313-598-6638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 BEECHWOOD ST",
            "city": "RIVER ROUGE",
            "state": "MI",
            "postal_code": "482181041",
            "telephone_number": "313-386-2288",
            "fax_number": "313-386-5986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENKINS",
        "first_name": "DOROTHY",
        "middle_name": "BEATRICE",
        "name_prefix": "Mrs.",
        "credential": "DOCTOR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-03-19",
        "last_updated": "2010-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "2480017",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "1984150",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MI",
            "license": "1984159",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in River Rouge, MI

All providers in River Rouge, MI · Psychologist in Michigan

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 19, 2010. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.