Provider Demographics
NPI:1114213931
Name:ELWART, JOSEPH R (MA, LLP)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:R
Last Name:ELWART
Suffix:
Gender:M
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 ROSELAND AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-5014
Mailing Address - Country:US
Mailing Address - Phone:248-342-5047
Mailing Address - Fax:248-545-8510
Practice Address - Street 1:2007 ROSELAND AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-5014
Practice Address - Country:US
Practice Address - Phone:248-342-5047
Practice Address - Fax:248-545-8510
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008941103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling