DR. MARITACONSTANCE SUPAN (NPI# 1063663714) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063663714 |
| Entity Type | Individual |
| Full Name | DR. MARITACONSTANCE SUPAN |
| Credential | PH.D., LLP, DAPA |
| Practice Address |
934 Mason St Dearborn MI 48124-2215 |
| Practice Telephone | 3132788053 |
| Practice Fax Number | 3132788053 |
| Mailing Telephone | 3132788053 |
| Mailing Fax Number | 3132788053 |
| Enumeration Date | 2008-09-30 |
| Last Update Date | 2008-09-30 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
6301008934 | MI | Behavioral Health & Social Service Providers |
| N | 103TC2200X |
Psychologist Specialization: Clinical Child & Adolescent |
6301008934 | MI | Behavioral Health & Social Service Providers |
| Street Address |
934 MASON ST |
| City | DEARBORN |
| State | MI |
| Zip Code | 48124-2215 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396389524 | Pharma A, LLC | Pharmacy | 23916 Michigan Ave, Dearborn, MI 48124 | 2019-10-31 |
| 1225683725 | Aysha Said | Behavior Technician | 1369 Porter St, Dearborn, MI 48124 | 2019-08-02 |
| 1881257772 | Leen Nusairat | Internal Medicine | Beaumont Health-dearborn Campus, 18101 Oakwood Blvd, Dearborn, MI 48124 | 2019-04-17 |
| 1417413360 | Gary C. Veraghen, Dds, PC | Dentist | 22100 W. Outer Drive, Dearborn, MI 48124 | 2019-02-15 |
| 1982168787 | Fnu Asma Manzar | Physical Therapist | Global Physical Therapy Services, Inc, 22819 Michigan Avenue, Dearborn, MI 48124 | 2019-01-25 |
| 1639640162 | Jernia Lashawn Usher | Behavior Technician | 1360 Porter St Lower Level, Dearborn, MI 48124 | 2018-12-10 |
| 1710456470 | Samar Fouad Hannawi | Psychologist | 3815 Pelham Street, Suite #13, Dearborn, MI 48124 | 2018-11-24 |
| 1881178747 | Sarah Chehab | Psychologist | 835 Mason St Suite 220b, Dearborn, MI 48124 | 2018-09-17 |
| 1568948289 | Ibrahim M Basma | Pharmacist | 22521 Michigan Avenue, Dearborn, MI 48124 | 2018-07-16 |
| 1669961942 | Jacqueline E Domzalski | Technician, Other | 3231 S. Gulley, Suite E, Dearborn, MI 48124 | 2018-05-02 |
| Find all providers in zip 48124 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417575762 | Authenticity Psychological Services | Psychologist | 24314 Cherry Hill St, Dearborn, MI 48124-1358 | 2020-07-13 |
| 1144798216 | Janelle A Smith | Psychologist | 2881 Monroe St # 201, Dearborn, MI 48124-3475 | 2018-11-07 |
| 1881178747 | Sarah Chehab | Psychologist | 835 Mason St Suite 220b, Dearborn, MI 48124 | 2018-09-17 |
| 1851696488 | Ellen Louise Keyt | Psychologist | Counseling & Resource Center of Dearborn, 19855 W. Outer Drive, Dearborn, MI 48124 | 2011-01-12 |
| 1649574526 | Tiffany Zlatich Tuttle | Psychologist | 19855 West Outer Dr Ste 104w, Dearborn, MI 48124-2022 | 2011-01-06 |
| 1689984213 | Justin Wayne Peer | Psychologist | 1 Parklane Blvd Ste 1210e, Dearborn, MI 48126-4283 | 2010-10-17 |
| 1952637126 | Melissa Marie Farrell | Psychologist | 1 Parklane Blvd, Dearborn, MI 48126 | 2009-10-23 |
| 1558594283 | George Psychological Services PC | Psychologist | 2314 Monroe, Dearborn, MI 48124-3045 | 2009-08-28 |
| 1588710222 | Manuel Alexander Manrique | Psychologist | 22967 Outer Dr, Dearborn, MI 48124-4248 | 2007-01-26 |
| 1295898112 | Amy J Charness | Psychologist | 23810 Michigan Ave, Suite 202b, Dearborn, MI 48124-1830 | 2006-12-19 |
| Find all providers in DEARBORN | ||||
Please comment or provide details below to improve the information on DR. MARITACONSTANCE SUPAN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.