NPIMap

Individual provider Active NPI

John Burke Eitzen, LLMSW, PH.D.

  • Clinical Social Worker
  • Marine City, MI
National Provider Identifier
1659600401
Registry record updated Dec 8, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801091557 Issued in MI
Practice address
156 Chartier
#2
Marine City, MI 48039-2344
Phone
(810) 765-3919
NPI assigned
Dec 8, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 6801091557 MI Primary

Addresses

Primary practice location

156 Chartier
#2
Marine City, MI 48039-2344

Mailing address

156 Chartier
#2
Marine City, MI 48039-2344
Phone (810) 765-3919

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health System Past Accepting new patients

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": "1260230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1260230400000",
    "number": "1659600401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "156 CHARTIER",
            "address_2": "#2",
            "city": "MARINE CITY",
            "state": "MI",
            "postal_code": "480392344",
            "telephone_number": "810-765-3919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "156 CHARTIER",
            "address_2": "#2",
            "city": "MARINE CITY",
            "state": "MI",
            "postal_code": "480392344",
            "telephone_number": "810-765-3919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EITZEN",
        "first_name": "JOHN",
        "middle_name": "BURKE",
        "name_prefix": "Dr.",
        "credential": "LLMSW, PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-12-08",
        "last_updated": "2009-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801091557",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marine City, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.