Provider Demographics
NPI:1891897047
Name:GOUSEINOV, YELENA (LMSW)
Entity Type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:GOUSEINOV
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:YELENA
Other - Middle Name:
Other - Last Name:ZALEVSKY; RACHENKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1547 S WAYNE RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-5436
Mailing Address - Country:US
Mailing Address - Phone:734-729-3133
Mailing Address - Fax:
Practice Address - Street 1:1547 S WAYNE RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-5436
Practice Address - Country:US
Practice Address - Phone:734-729-3133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801077748104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker