Provider Demographics
NPI:1477672459
Name:NIEMIERA, EILEEN (PHD LCPC)
Entity Type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:
Last Name:NIEMIERA
Suffix:
Gender:F
Credentials:PHD LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5101 W 105TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-5122
Mailing Address - Country:US
Mailing Address - Phone:708-278-2839
Mailing Address - Fax:708-422-2839
Practice Address - Street 1:10610 S CICERO AVE STE 4
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-5298
Practice Address - Country:US
Practice Address - Phone:708-364-7046
Practice Address - Fax:708-364-7048
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004583101YM0800X
IL101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180004583OtherBCBSIL