Provider Demographics
NPI:1437763687
Name:MAISTRENKO, JELENA (LCSW)
Entity Type:Individual
Prefix:
First Name:JELENA
Middle Name:
Last Name:MAISTRENKO
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 1:440 SANDPIPER CT APT D
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-4076
Mailing Address - Country:US
Mailing Address - Phone:331-425-5342
Mailing Address - Fax:
Practice Address - Street 1:1100 JORIE BLVD STE 132
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-4402
Practice Address - Country:US
Practice Address - Phone:331-425-5342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0218161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical