Provider Demographics
NPI:1467819425
Name:EITEN, ELIZABETH ROSE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ROSE
Last Name:EITEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36800 WOODWARD AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-0916
Mailing Address - Country:US
Mailing Address - Phone:248-593-8540
Mailing Address - Fax:
Practice Address - Street 1:36800 WOODWARD AVE STE 112
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-0916
Practice Address - Country:US
Practice Address - Phone:248-593-8540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010951691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical