Provider Demographics
NPI:1275268146
Name:KEARNEY, ELIZABETH MARY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:MARY
Last Name:KEARNEY
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 1:2619 W RICE ST FL 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-4541
Mailing Address - Country:US
Mailing Address - Phone:224-234-5365
Mailing Address - Fax:
Practice Address - Street 1:2000 N RACINE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-7006
Practice Address - Country:US
Practice Address - Phone:773-413-9523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-23
Last Update Date:2022-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0934211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical