Provider Demographics
NPI:1154642254
Name:SPICER, ELAINE (LCSW)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:SPICER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 N WARREN ST
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46403-1560
Mailing Address - Country:US
Mailing Address - Phone:219-512-2642
Mailing Address - Fax:
Practice Address - Street 1:1225 N WARREN ST
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46403-1560
Practice Address - Country:US
Practice Address - Phone:219-512-2642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-13
Last Update Date:2010-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34000821A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical