Provider Demographics
NPI:1619274636
Name:DANIEL J. KACHMAN, ED. D., P.C.
Entity type:Organization
Organization Name:DANIEL J. KACHMAN, ED. D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:KACHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:810-664-4363
Mailing Address - Street 1:2791 GUELPH CT
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48461-7927
Mailing Address - Country:US
Mailing Address - Phone:810-664-4363
Mailing Address - Fax:
Practice Address - Street 1:2791 GUELPH CT
Practice Address - Street 2:
Practice Address - City:NORTH BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48461-7927
Practice Address - Country:US
Practice Address - Phone:810-664-4363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-28
Last Update Date:2025-05-02
Deactivation Date:2014-04-28
Deactivation Code:
Reactivation Date:2014-07-21
Provider Licenses
StateLicense IDTaxonomies
103TC0700X
MI4101005376251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0D44517Medicaid