MEDICARE: JANICE MARIE ELSMAN MA, LLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	6301002894	MI

General Provider Information

NPI Number	:	1063595155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE MARIE ELSMAN MA, LLP

Provider Business Mailing Address
First Line	:	4811 BURNLEY DR
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48304-3781
Country	:	US
Telephone Number	:	248-626-0636
Fax Number	:	248-391-7478

Provider Business Practice Location Address
First Line	:	7457 FRANKLIN RD
Second Line	:	SUITE 303
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48301-3611
Country	:	US
Telephone Number	:	248-626-0636
Fax Number	:	248-391-7478

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	07/08/2007

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