Basic Information
| Provider Information | |||||||||
| NPI: | 1922437664 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JAWORSKI | ||||||||
| FirstName: | ELIZABETH | ||||||||
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| Credential: | LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 705 S MAIN ST | ||||||||
| Address2: | SUITE 280 | ||||||||
| City: | PLYMOUTH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481702089 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 705 S MAIN ST | ||||||||
| Address2: | SUITE 280 | ||||||||
| City: | PLYMOUTH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481702089 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344543560 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2013 | ||||||||
| LastUpdateDate: | 11/04/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 6301015143 | MI | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.