NPIMap

Organization Active NPI

Core Psych PLLC

  • Psychiatry Physician
  • Dearborn, MI
National Provider Identifier
1871069039
Registry record updated Jul 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
CORE PSYCH PLLC
Practice address
3815 Pelham St
Dearborn, MI 48124-3852
Phone
(313) 429-0470
NPI assigned
Oct 15, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2021

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

Authorized official

Name
Dr. Shady Shebak, MDNPI 1629416169
Title
Psychiatrist
Phone
(313) 429-0470

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 13

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X
Addiction (Substance Use Disorder) PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TA0400X
Cognitive & Behavioral PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TB0200X
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X
Counseling PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC1900X
Intellectual & Developmental Disabilities PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TM1800X
Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 104100000X
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X
Psychiatric PharmacistGroup: 193200000X MULTI-SPECIALTY GROUP 1835P1300X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X

Addresses

Primary practice location

3815 Pelham St
Dearborn, MI 48124-3852

Mailing address

3815 Pelham St Ste 13
Dearborn, MI 48124-3852
Phone (313) 680-0804

Other practice location 1

17330 Farmington Rd
Livonia, MI 48152-3158
Phone (734) 855-4883

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address core_psych@outlook.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190115000198 MI Part B Supplier - Clinic/Group Practice 8325384225 Receives reassigned benefits from 14 practitioners
Practice locations: Garden City, MI; Westland, MI; Mount Clemens, MI; Livonia, MI; Dearborn, MI

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D2221103Core Psych, PLLC3815 Pelham Street Suite 13, Dearborn, MI 48124Certificate of waiverApr 18, 2027

National Provider Directory

National Provider Directory

Locations

17330 Farmington Rd
Livonia, MI 48152
Phone (313) 722-4683

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1539561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625702400000",
    "number": "1871069039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3815 PELHAM ST STE 13",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481243852",
            "telephone_number": "313-680-0804",
            "fax_number": "313-241-9342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3815 PELHAM ST",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481243852",
            "telephone_number": "313-429-0470"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17330 Farmington Rd",
            "address_purpose": "LOCATION",
            "city": "Livonia",
            "state": "MI",
            "postal_code": "481523158",
            "country_code": "US",
            "telephone_number": "734-855-4883",
            "fax_number": "313-241-9342",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CORE PSYCH PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-15",
        "last_updated": "2021-07-08",
        "certification_date": "2021-07-08",
        "status": "A",
        "authorized_official_last_name": "SHEBAK",
        "authorized_official_first_name": "SHADY",
        "authorized_official_title_or_position": "PSYCHIATRIST",
        "authorized_official_telephone_number": "313-429-0470",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TM1800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1835P1300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pharmacist, Psychiatric",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "core_psych@outlook.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "3815 Pelham St",
            "city": "Dearborn",
            "state": "MI",
            "country_code": "US",
            "postal_code": "481243852",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Dearborn, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.