Organization
GERIATRIC PSYCHIATRIC SERVICES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT A CLEMENTE (MANAGER)
(586) 620-8100
Entity
Organization
Contact information
Practice address
1715 INDIAN WOOD CIR STE 200, MAUMEE, OH 43537-4055
(877) 906-9699
Mailing address
39465 W 14 MILE RD, NOVI, MI 48377-1600
(248) 859-3900
(888) 483-0118
Taxonomy
Speciality
Code
Description
License number
State
103TA0700X
Adult Development & Aging Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
260F340040
BCBS PHYSICIAN GROUP
MI
Enumeration date
06/08/2006
Last updated
07/01/2025
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