Active NPI
Jordan M. Braciszewski, PH.D.
- Psychologist
- Detroit, MI
National Provider Identifier
1891093399
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 6301016725
- Practice address
- 2799 W Grand Blvd
Detroit, MI 48202-2689 - Phone
- (313) 916-2600
- NPI assigned
- Mar 8, 2011
- Sex
- Male
- 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 | 6301016725 | MI | Primary |
Addresses
Primary practice location
2799 W Grand Blvd
Detroit, MI 48202-2689
Mailing address
50 Health LN
Warwick, RI 02886-2711
Phone (401) 732-5656
Other practice location 1
6777 W Maple Rd
West Bloomfield, MI 48322-3013
Phone (248) 325-1000
Other practice location 2
35980 Woodward Ave Ste 100
Bloomfield Hills, MI 48304-0903
Phone (248) 220-3332
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)
- Enrolled
- Credentials
- Doctor of Philosophy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Monarch Behavioral Health, PLLC | Psychologist | Past | Accepting new patients |
| Henry Ford Maplegrove Center | Past | Accepting new patients |
Interoperability endpoints
- jbraciszewski419455@direct.hfhs.org
Organizations & group practices 2
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.
-
- Children's Substance Abuse Rehabilitation Facility
- West Bloomfield, MI
- NPI 1295767630
-
- Psychologist
- Bloomfield Hills, MI
- NPI 1497272496
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1299542400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1522195200000",
"number": "1891093399",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "50 HEALTH LN",
"city": "WARWICK",
"state": "RI",
"postal_code": "028862711",
"telephone_number": "401-732-5656",
"fax_number": "401-738-8634"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2799 W GRAND BLVD",
"city": "DETROIT",
"state": "MI",
"postal_code": "482022689",
"telephone_number": "313-916-2600"
}
],
"practiceLocations": [
{
"address_1": "6777 W Maple Rd",
"address_purpose": "LOCATION",
"city": "West Bloomfield",
"state": "MI",
"postal_code": "483223013",
"country_code": "US",
"telephone_number": "248-325-1000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "35980 Woodward Ave Ste 100",
"address_purpose": "LOCATION",
"city": "Bloomfield Hills",
"state": "MI",
"postal_code": "483040903",
"country_code": "US",
"telephone_number": "248-220-3332",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BRACISZEWSKI",
"first_name": "JORDAN",
"middle_name": "M.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-03-08",
"last_updated": "2018-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MI",
"license": "6301016725",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.