Provider Demographics
NPI:1811997174
Name:CRAINE, ELLEN M (JD, LMSW, ACSW)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:M
Last Name:CRAINE
Suffix:
Gender:F
Credentials:JD, LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7221 ILANAWAY DR
Mailing Address - Street 2:
Mailing Address - City:ORCHARD LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48324-2489
Mailing Address - Country:US
Mailing Address - Phone:248-539-3850
Mailing Address - Fax:248-539-9110
Practice Address - Street 1:31874 NORTHWESTERN HWY
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-1628
Practice Address - Country:US
Practice Address - Phone:248-539-3850
Practice Address - Fax:248-539-9110
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI08817795121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical