Organization
DEVELOPMENT CENTERS
Active
Organization
DEVELOPMENT CENTERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CATHERINE L LIESMAN PH.D. (CHIEF EXECUTIVE OFFICER)
(313) 531-2500
Entity
Organization
Contact information
Practice address
24424 W MCNICHOLS RD, DETROIT, MI 48219-3653
(313) 255-0900
Mailing address
17421 TELEGRAPH RD, DETROIT, MI 48219-3165
(313) 531-2500
(313) 255-3465
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
260Q276040
BCBS - DOCTOR GROUP
—
01
—
750910618
BCBSM STATE EMPL ADULT
—
01
—
800H217310
BCBS - CSW GROUP
—
01
—
P94406
BLUE CARE NETWORK
—
Enumeration date
10/07/2014
Last updated
10/18/2019
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up