Provider Demographics
NPI:1669458980
Name:THOMASMA, ELLEN J (LMSW, ACSW)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:J
Last Name:THOMASMA
Suffix:
Gender:F
Credentials:LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 SHIAWASEE LN
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49127-1352
Mailing Address - Country:US
Mailing Address - Phone:269-429-8248
Mailing Address - Fax:
Practice Address - Street 1:3888 NILES RD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-8612
Practice Address - Country:US
Practice Address - Phone:269-428-5069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010599321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical