Provider Demographics
NPI:1417156738
Name:CLARKE, ELIZABETH BIERBAUM (LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BIERBAUM
Last Name:CLARKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:BIERBAUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:636 CHURCH ST STE 418
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4580
Mailing Address - Country:US
Mailing Address - Phone:773-484-7140
Mailing Address - Fax:
Practice Address - Street 1:636 CHURCH ST STE 418
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4580
Practice Address - Country:US
Practice Address - Phone:773-484-7140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical