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General NPI Number Information
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NPI Number | 1356659411
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Entity Type | Individual
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Provider Name | ELISE M MCNULTY LMSW
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Gender | Female
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Dates
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Enumeration Date | 09/22/2010
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 266 CONSTITUTION ST
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City | CANTON
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State | MI
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Zip | 48188-6719
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Country | US
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Telephone | 517-403-8493
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Fax |
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Provider Business Mailing Address
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Address Line | 7184 PAMELA DR
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City | YPSILANTI
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State | MI
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Zip | 48197-1773
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Country | US
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Telephone | 517-403-8493
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801092115
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License Number State | MI
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