MEDICARE: ELAINE SPICER 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	34000821A	IN

General Provider Information

NPI Number	:	1154642254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELAINE SPICER LCSW

Provider Business Mailing Address
First Line	:	1225 N WARREN ST
Second Line	:
City	:	GARY
State	:	IN
Zip	:	46403-1560
Country	:	US
Telephone Number	:	219-512-2642
Fax Number	:

Provider Business Practice Location Address
First Line	:	1225 N WARREN ST
Second Line	:
City	:	GARY
State	:	IN
Zip	:	46403-1560
Country	:	US
Telephone Number	:	219-512-2642
Fax Number	:

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

Provider Enumeration Date	:	06/13/2010
Last Update Date	:	06/13/2010

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Directions to “ ELAINE SPICER LCSW” Practice Location

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