Provider Demographics
NPI:1275704033
Name:ELENICH, GREG ALLEN (MSW)
Entity Type:Individual
Prefix:MR
First Name:GREG
Middle Name:ALLEN
Last Name:ELENICH
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13295 ILLINOIS ST
Mailing Address - Street 2:SUITE # 311
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-3019
Mailing Address - Country:US
Mailing Address - Phone:317-457-1481
Mailing Address - Fax:
Practice Address - Street 1:13295 ILLINOIS ST
Practice Address - Street 2:SUITE # 311
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3019
Practice Address - Country:US
Practice Address - Phone:317-457-1481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker