MEDICARE: ELISSA RUTH DRIKER LMSW LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6801067068	MI

General Provider Information

NPI Number	:	1225333032
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELISSA RUTH DRIKER LMSW LLC

Provider Business Mailing Address
First Line	:	628 E PARENT AVE
Second Line	:	SUITE 102
City	:	ROYAL OAK
State	:	MI
Zip	:	48067-3765
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	628 E PARENT AVE
Second Line	:	SUITE 102
City	:	ROYAL OAK
State	:	MI
Zip	:	48067-3765
Country	:	US
Telephone Number	:	248-376-5330
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	ELISSA DRIKER
Credential	:
Telephone Number	:	248-376-5330

Provider Enumeration Date	:	01/26/2011
Last Update Date	:	01/26/2011

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