Organization
MODERN PSYCH AND WELLNESS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANA SUCCURRO MD (OWNER)
(248) 667-8014
Entity
Organization
Contact information
Practice address
21415 GODDARD RD, TAYLOR, MI 48180-4247
(313) 737-0023
Mailing address
21415 GODDARD RD, TAYLOR, MI 48180-4247
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
207R00000X
Internal Medicine Physician
—
—
2084P0800X
Psychiatry Physician
—
—
Other
Enumeration date
05/09/2024
Last updated
03/18/2025
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