Provider Demographics
NPI:1366636102
Name:EPSTEIN, ELAINE BETH (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:BETH
Last Name:EPSTEIN
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20411 W 12 MILE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-6404
Mailing Address - Country:US
Mailing Address - Phone:866-703-1901
Mailing Address - Fax:866-703-1906
Practice Address - Street 1:20411 W 12 MILE RD STE 101
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-6404
Practice Address - Country:US
Practice Address - Phone:866-703-1901
Practice Address - Fax:866-703-1906
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013058103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist