Provider Demographics
NPI:1326118472
Name:SIMON-ROPER, ELIZABETH J (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:J
Last Name:SIMON-ROPER
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 1:38735 N MUNN RD
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLA
Mailing Address - State:IL
Mailing Address - Zip Code:60046-7764
Mailing Address - Country:US
Mailing Address - Phone:847-356-5470
Mailing Address - Fax:
Practice Address - Street 1:4180 STATE HIGHWAY 83
Practice Address - Street 2:SUITE 204
Practice Address - City:LONG GROVE
Practice Address - State:IL
Practice Address - Zip Code:60047
Practice Address - Country:US
Practice Address - Phone:224-688-8167
Practice Address - Fax:847-356-5470
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0024581041C0700X
WI2412-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical