Tabak, Ellen Rose

Tabak, Ellen Rose is an individual health care provider with primary practice located at 101 W Long Lake Rd , Bloomfield Hills MI 48304-2749. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Tabak, Ellen Rose can be contacted via phone (248) 480-4965.

Contact Information

Primary practice address
101 W Long Lake Rd Bloomfield Hills MI 48304-2749
Phone: (248) 480-4965
Fax: (248) 480-4966
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 6801018478 Michigan

Profile Details

NPI number 1396743704
LBN Legal business name Tabak, Ellen Rose
Credentials ACSW, M.A.
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 9th, 2005
Last updated Oct 7th, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1396743704 NPPES
Michigan Other 382778765 CIGNA / VENDOR # 1139981
Michigan Other 750910718 CIGNA / VENDOR # 1139981
Michigan Other 247423000 CIGNA / VENDOR # 1139981
Michigan Other 51940-01 CIGNA / VENDOR # 1139981
Michigan Other 9359445 CIGNA / VENDOR # 1139981

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