Provider Demographics
NPI:1770658197
Name:SMIECINSKI, ELLEN VICTORIA (LMSW, ACSW)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:VICTORIA
Last Name:SMIECINSKI
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 1:16268 TRUWOOD ST
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48183-1622
Mailing Address - Country:US
Mailing Address - Phone:734-675-0144
Mailing Address - Fax:
Practice Address - Street 1:19291 NORTHLINE RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2220
Practice Address - Country:US
Practice Address - Phone:734-287-1500
Practice Address - Fax:734-287-1660
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010585991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical