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Individual
MRS. ELLEN ROSE TABAK
Active
Individual
MRS. ELLEN ROSE TABAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACSW, M.A.
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6801018478
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
247423000
MAGELLAN BEHAVIORAL OF MI
—
01
—
382778765
CIGNA / VENDOR # 1139981
MI
01
—
51940-01
MT CARMEL BEHAVIORAL HLTH
—
01
—
750910718
BLUE CROSS BLUE SHIELD
MI
01
—
9359445
PRIVATE HEALTHCARE SYSTEM
—
Enumeration date
07/09/2005
Last updated
10/07/2019
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