Provider Demographics
NPI:1508337452
Name:MARBOE, ELINOR
Entity Type:Individual
Prefix:
First Name:ELINOR
Middle Name:
Last Name:MARBOE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 E HYDE PARK BLVD APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-2913
Mailing Address - Country:US
Mailing Address - Phone:914-450-6223
Mailing Address - Fax:
Practice Address - Street 1:3047 N LINCOLN AVE UNIT 400
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-4274
Practice Address - Country:US
Practice Address - Phone:773-494-5505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.103468104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker