Healthcare Provider Details

I. General information

NPI: 1972890143
Provider Name (Legal Business Name): ELAINE AAREN GORDON LCSW, CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2011
Last Update Date: 12/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3047 N LINCOLN AVE
CHICAGO IL
60657-4999
US

IV. Provider business mailing address

3047 N LINCOLN AVE
CHICAGO IL
60657-4999
US

V. Phone/Fax

Practice location:
  • Phone: 773-494-5505
  • Fax: 773-404-5837
Mailing address:
  • Phone: 773-494-5505
  • Fax: 773-404-5837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number27656
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149-014232
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.014232
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: