Provider Demographics
NPI:1689611279
Name:RUSSMAN, ELAINE TANZMAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:TANZMAN
Last Name:RUSSMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33045 HAMILTON CT
Mailing Address - Street 2:SUITE W-300
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3385
Mailing Address - Country:US
Mailing Address - Phone:248-848-1558
Mailing Address - Fax:248-848-3592
Practice Address - Street 1:33045 HAMILTON CT
Practice Address - Street 2:SUITE W-300
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3385
Practice Address - Country:US
Practice Address - Phone:248-848-1558
Practice Address - Fax:248-848-3592
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI003348103TC0700X
103TC2200X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy