=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164917480
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARMEN ELIAS LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2018
-----------------------------------------------------
Last Update Date | 07/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 41400 DEQUINDRE RD STE 110
-----------------------------------------------------
City | STERLING HEIGHTS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48314-3751
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-580-2975
-----------------------------------------------------
Fax | 586-580-2954
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23328 HAZELWOOD AVE
-----------------------------------------------------
City | HAZEL PARK
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48030-2716
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-775-0677
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 6801102728
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------