Active NPI
Christine Rose Mandich, MALLP
- Psychologist
- Clinton Township, MI
National Provider Identifier
1710059076
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 6301009728
- Practice address
- 43411 Garfield Rd Ste a
Clinton Township, MI 48038-1152 - Phone
- (586) 263-2760
- Fax
- (586) 263-2762
- NPI assigned
- Nov 14, 2006
- 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 | 6301009728 | MI | Primary |
Addresses
Primary practice location
43411 Garfield Rd Ste a
Clinton Township, MI 48038-1152
Mailing address
20864 Parkcrest Dr
Harper Woods, MI 48225-1708
Phone (586) 263-2760
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301009728 | MI | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163462400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1611187200000",
"number": "1710059076",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20864 PARKCREST DR",
"city": "HARPER WOODS",
"state": "MI",
"postal_code": "482251708",
"telephone_number": "586-263-2760",
"fax_number": "586-263-2762"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "43411 GARFIELD RD STE A",
"city": "CLINTON TOWNSHIP",
"state": "MI",
"postal_code": "480381152",
"telephone_number": "586-263-2760",
"fax_number": "586-263-2762"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANDICH",
"first_name": "CHRISTINE",
"middle_name": "ROSE",
"credential": "MALLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-14",
"last_updated": "2021-01-21",
"certification_date": "2021-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MI",
"license": "6301009728",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clinton Township, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.