Provider Demographics
NPI:1538351051
Name:AXELRAD, KENNETH (PHD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:AXELRAD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 36271
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-0271
Mailing Address - Country:US
Mailing Address - Phone:586-775-0357
Mailing Address - Fax:586-775-0357
Practice Address - Street 1:27472 SCHOENHERR RD STE 105
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-6687
Practice Address - Country:US
Practice Address - Phone:586-775-0357
Practice Address - Fax:586-775-0357
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist