Provider Demographics
NPI:1376011791
Name:LIOSSIS, ELENI S (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ELENI
Middle Name:S
Last Name:LIOSSIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:ELENI
Other - Middle Name:S
Other - Last Name:LIOSSIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD, ATR, LPC
Mailing Address - Street 1:825 N CASS AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-6401
Mailing Address - Country:US
Mailing Address - Phone:630-447-9737
Mailing Address - Fax:
Practice Address - Street 1:825 N CASS AVE STE 109
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-6401
Practice Address - Country:US
Practice Address - Phone:630-447-9737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-03
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.008897103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical