NPI 1891093399 · live from the CMS NPI Registry
Jordan M. Braciszewski, Ph.D.
Psychologist in Detroit, MI. National Provider Identifier 1891093399, active.
NPI record
| NPI | 1891093399 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Psychologist 103T00000X |
| Practice location | 2799 W Grand Blvd, Detroit, MI 48202 |
| Practice phone | 313-916-2600 |
| Mailing address | 50 Health Ln, Warwick, RI 02886 |
| Enumerated | March 8, 2011 |
| Last updated | March 28, 2018 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Psychologist primary | 103T00000X | 6301016725 (MI) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.