Healthcare Provider Details

I. General information

NPI: 1326809658
Provider Name (Legal Business Name): ELENI VRAHNOS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2024
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41740 6 MILE RD STE 103
NORTHVILLE MI
48168-4383
US

IV. Provider business mailing address

1009 SPRINGFIELD CT
NORTHVILLE MI
48167-1029
US

V. Phone/Fax

Practice location:
  • Phone: 734-542-6969
  • Fax:
Mailing address:
  • Phone: 313-418-4305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801114539
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: