Provider Demographics
NPI:1902944978
Name:PARE', ELLEN SUE (LBSW)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:SUE
Last Name:PARE'
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:SUE
Other - Last Name:STOLZENFELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15003 CAMDEN AVE
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-1501
Mailing Address - Country:US
Mailing Address - Phone:586-773-5381
Mailing Address - Fax:
Practice Address - Street 1:46360 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48051-2800
Practice Address - Country:US
Practice Address - Phone:586-948-0228
Practice Address - Fax:586-948-0213
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802065871104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker