Provider Demographics
NPI:1174550263
Name:COVEN, ROBERTA W (PHD)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:W
Last Name:COVEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2065 NORTH HAMMOND
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323
Mailing Address - Country:US
Mailing Address - Phone:248-875-3245
Mailing Address - Fax:248-451-9089
Practice Address - Street 1:1750 S TELEGRAPH RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0166
Practice Address - Country:US
Practice Address - Phone:248-451-9085
Practice Address - Fax:248-451-9089
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI005337101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIR66834Medicare UPIN