Ellen Rose Tabak, ACSW, M.A.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801018478 Issued in MI

Practice address

101 W Long Lake Rd
Bloomfield Hills, MI 48304-2749

Phone

(248) 480-4965

Fax

(248) 480-4966

NPI assigned

Jul 9, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 5

Other names 1

• Ms. Ellen Rose Brooks Former name

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

Specialty

Clinical Social Worker

Education

Other, 1980

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

Practice roles

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.

• American Arthritis & Rheumatology Associates -Mi PLLC

  • Rheumatology Physician
  • Sterling Heights, MI
  • NPI 1538655469
  NPD (past)
• Personal & Family Adjustment Center PC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Birmingham, MI
  • NPI 1669478921
  NPD (past)

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

{
    "created_epoch": "1120867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570406400000",
    "number": "1396743704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1960 GOLF RIDGE DR",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483021725",
            "telephone_number": "248-538-9666",
            "fax_number": "248-538-9666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 W LONG LAKE RD",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483042749",
            "telephone_number": "248-480-4965",
            "fax_number": "248-480-4966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TABAK",
        "first_name": "ELLEN",
        "middle_name": "ROSE",
        "name_prefix": "Mrs.",
        "credential": "ACSW, M.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-09",
        "last_updated": "2019-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801018478",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA / VENDOR # 1139981",
            "identifier": "382778765",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "750910718",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN BEHAVIORAL OF MI",
            "identifier": "247423000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MT CARMEL BEHAVIORAL HLTH",
            "identifier": "51940-01",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIVATE HEALTHCARE SYSTEM",
            "identifier": "9359445",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELLEN",
            "last_name": "BROOKS",
            "middle_name": "ROSE",
            "prefix": "MS.",
            "credential": "ACSW, M.A.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Synergy Consulting, LLC
• Synergy Home Health System
• Joan Saad Syoufjy, PHARMD
• David Szczesny, PT, DPT
• Carly Ann Szurek, DDS
• Yvette Marie Tabangay, DDS
• Tactile Systems Technology, Inc
• Jaclyn Talon
• Ruchi Tandon
• Jaime Lyn-Essian Taylor, D.O.

• Clinical Social Worker in Bloomfield Hills, MI
• Providers in Bloomfield Hills, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.