NPIMap

Organization Active NPI

Northbrook Psychological Clinic PLC

  • Psychologist
  • Novi, MI
National Provider Identifier
1841279288
Registry record updated Oct 12, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
NORTHBROOK PSYCHOLOGICAL CLINIC PLC
Practice address
43450 W 10 Mile Rd
Novi, MI 48375-3172
Phone
(248) 344-7420
Fax
(248) 344-7423
NPI assigned
Jan 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2007

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

Authorized official

Name
Pamela D Kresta, PSYDNPI 1568519528
Title
Owner
Phone
(248) 344-7420

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X Primary

Addresses

Primary practice location

43450 W 10 Mile Rd
Novi, MI 48375-3172

Mailing address

43450 W 10 Mile Rd
Novi, MI 48375-3172
Phone (248) 344-7420

Other identifiers 1

IdentifierTypeStateIssuer
8008927170OtherMIBCBS SOCIAL WORKER

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040514001041 MI Part B Supplier - Clinic/Group Practice 3577456243 Receives reassigned benefits from 7 practitioners
Practice locations: Novi, MI

National Provider Directory

National Provider Directory

Locations

43450 W 10 Mile Rd
Novi, MI 48375
Phone (248) 344-7420

23965 Novi Rd
Ste 110
Novi, MI 48375
Phone (248) 344-3172

Practitioners & affiliated clinicians

Practitioners 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1137110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192147200000",
    "number": "1841279288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43450 W 10 MILE RD",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483753172",
            "telephone_number": "248-344-7420",
            "fax_number": "248-344-7423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43450 W 10 MILE RD",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483753172",
            "telephone_number": "248-344-7420",
            "fax_number": "248-344-7423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHBROOK PSYCHOLOGICAL CLINIC PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-13",
        "last_updated": "2007-10-12",
        "status": "A",
        "authorized_official_last_name": "KRESTA",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-344-7420",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS SOCIAL WORKER",
            "identifier": "8008927170",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Novi, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2007; 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.