Provider Demographics
NPI:1871788331
Name:ELIZABETH W. BORG PHD DSC PC
Entity type:Organization
Organization Name:ELIZABETH W. BORG PHD DSC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:W
Authorized Official - Last Name:BORG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:734-453-2207
Mailing Address - Street 1:6426 KINGS MILL CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-5480
Mailing Address - Country:US
Mailing Address - Phone:734-453-2207
Mailing Address - Fax:734-453-8415
Practice Address - Street 1:580 FOREST AVE STE 1B
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1780
Practice Address - Country:US
Practice Address - Phone:734-453-2207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008127261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1952420168OtherNPI--SOLE PROVIDER NUMBER
MI0N20500Medicare PIN