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NPI Code Detail

MEDICARE: MS. EITHNE MARY KIELY LCSW

MEDICARE: MS. EITHNE MARY KIELY LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker149017739IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1149.017739OTHERILLCSW

General Provider Information

NPI Number : 1568900926
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. EITHNE MARY KIELY LCSW
Provider Business Mailing Address
First Line : 321 W CALENDAR AVE
Second Line : APT 3F
City : LA GRANGE
State : IL
Zip : 60525-2307
Country : US
Telephone Number : 773-383-9051
Fax Number :
Provider Business Practice Location Address
First Line : 1101 31ST ST STE 105
Second Line :
City : DOWNERS GROVE
State : IL
Zip : 60515-5535
Country : US
Telephone Number : 773-383-9051
Fax Number : 630-926-0640
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2017
Last Update Date : 10/10/2023

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