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NPI Code Detail

MEDICARE: DR. BETH MARIE ELIA PSYD

MEDICARE: DR. BETH MARIE ELIA PSYD
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
1103TC0700XClinical Psychologist071.007946IL
2103G00000XClinical Neuropsychologist071007946IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1071007946OTHERILSTATE OF ILLINOIS

General Provider Information

NPI Number : 1083921076
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BETH MARIE ELIA PSYD
Provider Business Mailing Address
First Line : 3209 N LAKEWOOD AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60657-3215
Country : US
Telephone Number : 872-274-4344
Fax Number : 866-671-9991
Provider Business Practice Location Address
First Line : 30 N MICHIGAN AVE STE 424
Second Line :
City : CHICAGO
State : IL
Zip : 60602-3844
Country : US
Telephone Number : 312-279-9981
Fax Number : 312-332-4281
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2010
Last Update Date : 12/11/2025

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