Healthcare Provider Details

I. General information

NPI: 1689611279
Provider Name (Legal Business Name): ELAINE TANZMAN RUSSMAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33045 HAMILTON CT SUITE W-300
FARMINGTON HILLS MI
48334-3385
US

IV. Provider business mailing address

33045 HAMILTON CT SUITE W-300
FARMINGTON HILLS MI
48334-3385
US

V. Phone/Fax

Practice location:
  • Phone: 248-848-1558
  • Fax: 248-848-3592
Mailing address:
  • Phone: 248-848-1558
  • Fax: 248-848-3592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number003348
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: