Provider Demographics
NPI:1861582777
Name:WARD, AGNES (MA, LLP)
Entity type:Individual
Prefix:MRS
First Name:AGNES
Middle Name:
Last Name:WARD
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:MISS
Other - First Name:AGNES
Other - Middle Name:
Other - Last Name:DMOCHOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LLP
Mailing Address - Street 1:27941 HARPER AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-1535
Mailing Address - Country:US
Mailing Address - Phone:586-944-6890
Mailing Address - Fax:
Practice Address - Street 1:27941 HARPER AVE STE 105
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1535
Practice Address - Country:US
Practice Address - Phone:586-944-6890
Practice Address - Fax:586-777-7855
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012533103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist