Basic Information
| Provider Information | |||||||||
| NPI: | 1366636102 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EPSTEIN | ||||||||
| FirstName: | ELAINE | ||||||||
| MiddleName: | BETH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PSYD, LP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20411 W 12 MILE RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480766404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8667031901 | ||||||||
| FaxNumber: | 8667031906 | ||||||||
| Practice Location | |||||||||
| Address1: | 20411 W 12 MILE RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480766404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8667031901 | ||||||||
| FaxNumber: | 8667031906 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2007 | ||||||||
| LastUpdateDate: | 04/15/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 6301013058 | MI | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.