Individual provider Active NPI

Elaine Beth Epstein, PSYD, LP

  • Psychologist
  • Southfield, MI
National Provider Identifier
1366636102
Registry record updated Apr 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
6301013058 Issued in MI
Practice address
20411 W 12 Mile Rd Ste 101
Southfield, MI 48076-6404
Phone
(866) 703-1901
Fax
(866) 703-1906
NPI assigned
Sep 5, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 15, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 6301013058 MI Primary

Addresses

Primary practice location

20411 W 12 Mile Rd Ste 101
Southfield, MI 48076-6404

Mailing address

20411 W 12 Mile Rd Ste 101
Southfield, MI 48076-6404
Phone (866) 703-1901

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170216001465 MI Practitioner - Clinical Psychologist 6002108446 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Dr Lainie Epstein PLLCGroup PAC ID 5193017531, 4 clinicians

Practice addresses (Care Compare)

20411 W 12 Mile Rd
101 Radical Well Being Center
Southfield, MI 48076-6404
Phone (866) 703-1901

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6301013058MIMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Dr. Lainie Epstein PLLC Psychologist CurrentSince Jun 1, 2016 Accepting new patients

Locations

26711 Woodward Ave
Ste 208
Huntington Woods, MI 48070
Phone (248) 703-4920

20411 W 12 Mile Rd
Ste 101
Southfield, MI 48076
Phone (248) 354-1888

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1188950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586908800000",
    "number": "1366636102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20411 W 12 MILE RD STE 101",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480766404",
            "telephone_number": "866-703-1901",
            "fax_number": "866-703-1906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20411 W 12 MILE RD STE 101",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480766404",
            "telephone_number": "866-703-1901",
            "fax_number": "866-703-1906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EPSTEIN",
        "first_name": "ELAINE",
        "middle_name": "BETH",
        "name_prefix": "Dr.",
        "credential": "PSYD, LP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-09-05",
        "last_updated": "2020-04-15",
        "certification_date": "2020-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301013058",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

Verify at the official NPI Registry.