Provider Demographics
NPI:1225302565
Name:COMELLO, ELISE L (LCSW)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:L
Last Name:COMELLO
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 1:39 GOLDENROD LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-2304
Mailing Address - Country:US
Mailing Address - Phone:608-335-7191
Mailing Address - Fax:
Practice Address - Street 1:619 RIVER ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53508-9188
Practice Address - Country:US
Practice Address - Phone:608-424-9100
Practice Address - Fax:608-424-9099
Is Sole Proprietor?:No
Enumeration Date:2012-03-05
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8235-1231041C0700X
WI128596121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical