Healthcare Provider Details

I. General information

NPI: 1588577480
Provider Name (Legal Business Name): ELLIOT EDGAR LLMSW-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RAINBOW EDGAR LLMSW-C

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 W HEWITT AVE
MARQUETTE MI
49855-3533
US

IV. Provider business mailing address

102 W HEWITT AVE
MARQUETTE MI
49855-3533
US

V. Phone/Fax

Practice location:
  • Phone: 906-365-3255
  • Fax:
Mailing address:
  • Phone: 906-231-3339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851116492
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: