Healthcare Provider Details

I. General information

NPI: 1205887940
Provider Name (Legal Business Name): ELIZABETH JANE PINER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 HAMILTON RD
OKEMOS MI
48864-1700
US

IV. Provider business mailing address

2109 HAMILTON RD
OKEMOS MI
48864-1700
US

V. Phone/Fax

Practice location:
  • Phone: 517-648-2939
  • Fax: 517-575-0253
Mailing address:
  • Phone: 517-648-2939
  • Fax: 517-575-0253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801067102
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: