Provider Demographics
NPI:1548336324
Name:KOVACH, BERNADETTE STARR (PHD)
Entity type:Individual
Prefix:DR
First Name:BERNADETTE
Middle Name:STARR
Last Name:KOVACH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:BERNADETTE
Other - Middle Name:STARR
Other - Last Name:KOVACH PHD., PLLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:31731 NORTHWESTERN HWY STE 110E
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-1654
Mailing Address - Country:US
Mailing Address - Phone:734-812-1157
Mailing Address - Fax:
Practice Address - Street 1:31731 NORTHWESTERN HWY STE 110E
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-1654
Practice Address - Country:US
Practice Address - Phone:734-812-1157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-26
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012246103T00000X
MI631012246103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH073475OtherBCBS GROUP
MIOH73060OtherBCBS