Provider Demographics
NPI:1871759910
Name:JANNETTE, CATERINA C (MA)
Entity type:Individual
Prefix:
First Name:CATERINA
Middle Name:C
Last Name:JANNETTE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53200 VAN DYKE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-2597
Mailing Address - Country:US
Mailing Address - Phone:586-707-6340
Mailing Address - Fax:
Practice Address - Street 1:53200 VAN DYKE AVE STE 100
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48316-2597
Practice Address - Country:US
Practice Address - Phone:586-707-6340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013513103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist