MEDICARE: KAREN MARIE ELBERT LMSW

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	104100000X	Social Worker	6801078716	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0896804	OTHER	MI	BC/BS

General Provider Information

NPI Number	:	1598870362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN MARIE ELBERT LMSW

Provider Business Mailing Address
First Line	:	2364 WHIMBREL CT NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49505-7156
Country	:	US
Telephone Number	:	616-930-3874
Fax Number	:	616-930-3875

Provider Business Practice Location Address
First Line	:	967 SPAULDING AVE SE STE D
Second Line	:
City	:	ADA
State	:	MI
Zip	:	49301-3703
Country	:	US
Telephone Number	:	616-930-3874
Fax Number	:	616-930-3875

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

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	10/22/2020

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