RENAISSANCE THERAPY CLINIC PLLC (NPI# 1407180284) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407180284 |
| Entity Type | Organization |
| Organization Name | RENAISSANCE THERAPY CLINIC PLLC |
| Practice Address |
1o West Square Lake Rd Suite 221 Bloomfield Hills MI 48302-0466 |
| Mailing Address |
1o West Square Lake Rd Suite 101 Bloomfield Hills MI 48302-0466 |
| Practice Telephone | 2489900140 |
| Mailing Telephone | 2489900140 |
| Mailing Fax Number | 8885109669 |
| Enumeration Date | 2009-09-25 |
| Last Update Date | 2010-07-27 |
| Authorized Official Name | DR. VLADIMIR ROBERT VANDALOV (OWNER) |
| Authorized Official Telephone | 2489900140 |
| Authorized Official Credential | PSYD, LPC, NCC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103TC0700X |
Psychologist Specialization: Clinical |
6301000821 | MI | Behavioral Health & Social Service Providers |
| N | 1041C0700X |
Social Worker Specialization: Clinical |
6801069906 | MI | Behavioral Health & Social Service Providers |
| Y | 101YP2500X |
Counselor Specialization: Professional |
6401005273 | MI | Behavioral Health & Social Service Providers |
| Street Address |
1O WEST SQUARE LAKE RD SUITE 221 |
| City | BLOOMFIELD HILLS |
| State | MI |
| Zip Code | 48302-0466 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386242634 | Lamuriel Lewis | Registered Nurse | 1430 South Telegraph Rd, Bloomfield Hills, MI 48302 | 2020-10-09 |
| 1730794082 | Ola Glezen | Registered Nurse | 1410 South Telegraph Road, Bloomfield Hills, MI 48302 | 2020-09-14 |
| 1114563400 | Henry Ford Health System | Pharmacy | 1961 S Telegraph Rd, Bloomfield Twp, MI 48302 | 2019-11-21 |
| 1508407982 | P-cor LLC | Eyewear Supplier (Equipment, not the service) | 1961 S. Telegraph Rd, Bloomfield Hills, MI 48302 | 2019-10-07 |
| 1144887936 | Christine Beth Wilson De Medina | Psychologist | W-4111 Andover Road, Bloomfield Hills, MI 48302 | 2019-05-28 |
| 1942793799 | Andrew Joseph Grix | Physical Therapist | 2525 S Telegraph Rd Ste 314, Bloomfield Hills, MI 48302 | 2018-06-06 |
| 1306398078 | Shaleene Mayo | Mechanotherapist | 43902 Woodward # 120, Bloomfield Hills, MI 48302 | 2016-10-28 |
| 1588112981 | Carol Van Kampen | Social Worker | 2550 S. Telegraph, Bloomfield Hills, MI 48302 | 2016-09-14 |
| 1770933848 | Rachelle Savalli | Family Medicine | 1961 South Telegraph Rd, Bloomfield Twp, MI 48302 | 2016-06-20 |
| 1699155366 | Aleksey Mishulin | Ophthalmology | 1750 S Telegraph Ste 205, Bloomfield Hills, MI 48302 | 2015-06-08 |
| Find all providers in zip 48302 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861004186 | Barbara Ruskin LLC | Counselor | 122 Barden Ct, Bloomfield Hills, MI 48304-2704 | 2020-08-18 |
| 1417433707 | Camille Harris | Counselor | 7457 Franklin Rd Ste 222, Bloomfield Hills, MI 48301-3612 | 2018-07-19 |
| 1447537261 | Freda Baran Lerman | Counselor | 6905 Telegraph Rd, Suite 100, Bloomfield Hills, MI 48301-3157 | 2011-11-08 |
| 1669796413 | Kimberly Zerhonda Brown | Counselor | 2550 S Telegraph Rd Ste 250, Bloomfield Hills, MI 48302-0909 | 2010-03-23 |
| 1982212262 | Pocs Counseling and Psychiatric Services PC | Counselor | 4111 Andover Rd, Suite 150, Bloomfield Hills, MI 48302-1909 | 2020-07-22 |
| 1528686524 | Sarah Cricket | Counselor | 43902 Woodward Ave Ste 230, Bloomfield Hills, MI 48302-5022 | 2020-07-07 |
| 1851877146 | Camille Harris Counseling Services LLC | Counselor | 7457 Franklin Rd Ste 222, Bloomfield Hills, MI 48301-3612 | 2018-07-19 |
| 1629563218 | Balance Link Therapy Group Pllc | Counselor | 41000 Woodward Ave Ste 350, Bloomfield Hills, MI 48304 | 2018-06-26 |
| 1477057206 | Angela Petz | Counselor | 2550 S Telegraph Rd Ste 250, Bloomfield Hills, MI 48302-0909 | 2018-03-19 |
| 1891187613 | Rebecca Lynn Verkest | Counselor | 1410 S Telegraph Rd, Bloomfield Hills, MI 48302-0046 | 2015-03-03 |
| Find all providers in BLOOMFIELD HILLS | ||||
| City | BLOOMFIELD HILLS |
| Zip Code | 48302 |
Please comment or provide details below to improve the information on RENAISSANCE THERAPY CLINIC PLLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.