Provider Demographics
NPI:1649790387
Name:ELIZABETH EITEN LMSW LLC
Entity type:Organization
Organization Name:ELIZABETH EITEN LMSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:EITEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:313-444-8301
Mailing Address - Street 1:36800 WOODWARD AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-0916
Mailing Address - Country:US
Mailing Address - Phone:248-593-8540
Mailing Address - Fax:
Practice Address - Street 1:36800 WOODWARD AVE STE 112
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-0916
Practice Address - Country:US
Practice Address - Phone:248-593-8540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010951691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty