Provider Demographics
NPI:1306584214
Name:MCRAE, ELIZABETH JANELLE I
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JANELLE
Last Name:MCRAE
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5129 MANGROVE DR
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-1142
Mailing Address - Country:US
Mailing Address - Phone:989-798-6742
Mailing Address - Fax:
Practice Address - Street 1:900 CENTER AVE
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-6189
Practice Address - Country:US
Practice Address - Phone:989-778-0127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician