MEDICARE: MR. MICHAEL ELLIOTT LCSW

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	1041C0700X	Clinical Social Worker	44SC05499300	NJ

General Provider Information

NPI Number	:	1700224409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL ELLIOTT LCSW

Provider Business Mailing Address
First Line	:	34 ORCHARD SQ
Second Line	:
City	:	CALDWELL
State	:	NJ
Zip	:	07006-5122
Country	:	US
Telephone Number	:	609-766-0426
Fax Number	:	609-474-3525

Provider Business Practice Location Address
First Line	:	34 ORCHARD SQ
Second Line	:
City	:	CALDWELL
State	:	NJ
Zip	:	07006-5122
Country	:	US
Telephone Number	:	609-766-0426
Fax Number	:	609-474-3525

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

Provider Enumeration Date	:	06/05/2013
Last Update Date	:	01/09/2026

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