Basic Information
| Provider Information | |||||||||
| NPI: | 1336167345 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROSEN | ||||||||
| FirstName: | ELLIOT | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | LMSW, LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 28000 DEQUINDRE RD | ||||||||
| Address2: | |||||||||
| City: | WARREN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480922468 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867530405 | ||||||||
| FaxNumber: | 5867530404 | ||||||||
| Practice Location | |||||||||
| Address1: | 17250 FARMINGTON RD | ||||||||
| Address2: | |||||||||
| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481523151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344254070 | ||||||||
| FaxNumber: | 7344258350 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6801001857 | MI | X | Behavioral Health & Social Service Providers | Social Worker | 106H00000X | 4101005859 | MI | X | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.