Healthcare Provider Details

I. General information

NPI: 1982937199
Provider Name (Legal Business Name): ELIEZER JOSEPH MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13560 76TH ST STE 3
SOUTH HAVEN MI
49090-9483
US

IV. Provider business mailing address

13560 76TH ST STE 3
SOUTH HAVEN MI
49090-9483
US

V. Phone/Fax

Practice location:
  • Phone: 269-921-3437
  • Fax: 888-412-1492
Mailing address:
  • Phone: 269-921-3437
  • Fax: 888-412-1492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33013277A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: