Active NPI
Laura Eyman Brdak, MA, LLP
- Clinical Psychologist
- Southfield, MI
National Provider Identifier
1720163355
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6301012402
- Practice address
- 22170 W 9 Mile Rd
Southfield, MI 48033-6007 - Phone
- (248) 372-6800
- NPI assigned
- Oct 25, 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6301012402 | MI | Primary |
Addresses
Primary practice location
22170 W 9 Mile Rd
Southfield, MI 48033-6007
Mailing address
16952 Kensington Dr
Macomb, MI 48044-4093
Phone (248) 302-0998
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301012402 | MI | MD | Clinical Psychologist |
Interoperability endpoints
- lbrdak1118627@direct.hfhs.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161734400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1441324800000",
"number": "1720163355",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16952 KENSINGTON DR",
"city": "MACOMB",
"state": "MI",
"postal_code": "480444093",
"telephone_number": "248-302-0998"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22170 W 9 MILE RD",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480336007",
"telephone_number": "248-372-6800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRDAK",
"first_name": "LAURA",
"middle_name": "EYMAN",
"credential": "MA, LLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-25",
"last_updated": "2015-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301012402",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.