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General NPI Number Information
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NPI Number | 1083921076
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Entity Type | Individual
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Provider Name | BETH MARIE ELIA PSYD
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Gender | Female
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Dates
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Enumeration Date | 09/12/2010
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 30 N MICHIGAN AVE STE 424
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City | CHICAGO
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State | IL
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Zip | 60602-3844
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Country | US
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Telephone | 312-279-9981
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Fax | 312-332-4281
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Provider Business Mailing Address
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Address Line | 3209 N LAKEWOOD AVE
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City | CHICAGO
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State | IL
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Zip | 60657-3215
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Country | US
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Telephone | 872-274-4344
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Fax | 866-671-9991
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071.007946
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 071007946
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License Number State | IL
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