Healthcare Provider Details

I. General information

NPI: 1942287289
Provider Name (Legal Business Name): ELIZABETH A AGUAYO MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 BROADWAY STE 108
CHESTERTON IN
46304-2477
US

IV. Provider business mailing address

436 SPRING CANYON DR
HEBRON IN
46341-8627
US

V. Phone/Fax

Practice location:
  • Phone: 219-433-3741
  • Fax:
Mailing address:
  • Phone: 219-433-3741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number87001144A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34006074A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: