MEDICARE: MRS. AMY MICHELLE ELIACIN MSW, 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
1	1041C0700X	Clinical Social Worker	149012414	IL

General Provider Information

NPI Number	:	1770700924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY MICHELLE ELIACIN MSW, LCSW

Provider Business Mailing Address
First Line	:	2215 LAKESIDE DR
Second Line	:
City	:	BANNOCKBURN
State	:	IL
Zip	:	60015-1265
Country	:	US
Telephone Number	:	224-268-0026
Fax Number	:

Provider Business Practice Location Address
First Line	:	2215 LAKESIDE DR
Second Line	:
City	:	BANNOCKBURN
State	:	IL
Zip	:	60015-1265
Country	:	US
Telephone Number	:	224-268-0026
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	11/05/2024

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