Provider Demographics
NPI:1518124692
Name:EVALUATION CENTER PC
Entity type:Organization
Organization Name:EVALUATION CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-932-8400
Mailing Address - Street 1:5755 W MAPLE RD
Mailing Address - Street 2:SUITE # 119
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4415
Mailing Address - Country:US
Mailing Address - Phone:248-932-8400
Mailing Address - Fax:248-932-0226
Practice Address - Street 1:5755 W MAPLE RD
Practice Address - Street 2:SUITE # 119
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4415
Practice Address - Country:US
Practice Address - Phone:248-932-8400
Practice Address - Fax:248-932-0226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-17
Last Update Date:2008-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1191059103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysisGroup - Single Specialty