Provider Demographics
NPI:1053078626
Name:PRUDHOMME, ELIZABETH LEE-SMITH (MSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LEE-SMITH
Last Name:PRUDHOMME
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:LEE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:950 W MONROE ST STE AAND600B
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-2079
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:950 W MONROE ST STE AAND600B
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-2079
Practice Address - Country:US
Practice Address - Phone:517-630-1570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker