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NPI Code Detail

MEDICARE: ELENA M MATTA LCSW

MEDICARE: ELENA M MATTA 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
11041C0700XClinical Social Worker149.028922IL

General Provider Information

NPI Number : 1942008008
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELENA M MATTA LCSW
Provider Business Mailing Address
First Line : 2020 DEMPSTER ST
Second Line :
City : EVANSTON
State : IL
Zip : 60202-1017
Country : US
Telephone Number : 847-905-0702
Fax Number :
Provider Business Practice Location Address
First Line : 2020 DEMPSTER ST
Second Line :
City : EVANSTON
State : IL
Zip : 60202-1017
Country : US
Telephone Number : 847-905-0702
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2025
Last Update Date : 06/09/2025

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Directions to “ ELENA M MATTA LCSW” Practice Location

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