MEDICARE: ELIZABETH CASACLANG-MELO MA, LPC, CADC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	30088	IL
2	101YP2500X	Professional Counselor	178.002996	IL

General Provider Information

NPI Number	:	1205348703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH CASACLANG-MELO MA, LPC, CADC

Provider Business Mailing Address
First Line	:	3976 N AVONDALE AVE FL 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-2900
Country	:	US
Telephone Number	:	630-428-7890
Fax Number	:

Provider Business Practice Location Address
First Line	:	3976 N AVONDALE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-2900
Country	:	US
Telephone Number	:	847-462-6099
Fax Number	:	847-628-6064

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

Provider Enumeration Date	:	10/25/2017
Last Update Date	:	11/15/2023

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