Organization
GERIATRIC PSYCHIATRIC SERVICES PLLC
Active
Parent organization
GERIATRIC PSYCHIATRIC SERVICES
Other names
Nurse Practitioner Group
Organization subpart
Yes
Provider details
NPI number
Legal business name
GERIATRIC PSYCHIATRIC SERVICES
Authorized official
ROBERT A CLEMENTE (MANAGER)
(586) 620-8100
Entity
Organization
Contact information
Practice address
28800 RYAN RD, SUITE 320, WARREN, MI 48092-4272
(586) 620-8100
(866) 227-7418
Mailing address
39465 W 14 MILE RD, NOVI, MI 48377-1600
(248) 859-3900
(888) 483-0118
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
—
—
363L00000X
Nurse Practitioner
Primary
—
—
364SA2200X
Adult Health Clinical Nurse Specialist
—
—
364SP0809X
Adult Psychiatric/Mental Health Clinical Nurse Specialist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
500F339520
BCBS PIN NUMBER
MI
Enumeration date
01/12/2009
Last updated
07/25/2024
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