Provider Demographics
NPI:1689965212
Name:ELYSE FINE LMSW ACSW PLLC
Entity Type:Organization
Organization Name:ELYSE FINE LMSW ACSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER CLINICAL
Authorized Official - Prefix:MS
Authorized Official - First Name:ELYSE
Authorized Official - Middle Name:
Authorized Official - Last Name:FINE
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:313-801-1285
Mailing Address - Street 1:32437 FIVE MILE RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-3039
Mailing Address - Country:US
Mailing Address - Phone:313-801-1285
Mailing Address - Fax:734-421-0306
Practice Address - Street 1:32437 FIVE MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-3039
Practice Address - Country:US
Practice Address - Phone:313-801-1285
Practice Address - Fax:734-421-0306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-01
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010573001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty