Provider Demographics
NPI:1558362442
Name:SQUIRES, ELAINE (LCSW)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:SQUIRES
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 1:3215 STECK AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-7566
Mailing Address - Country:US
Mailing Address - Phone:512-476-3556
Mailing Address - Fax:512-476-0195
Practice Address - Street 1:3215 STECK AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-7566
Practice Address - Country:US
Practice Address - Phone:512-476-3556
Practice Address - Fax:512-476-0195
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX322691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00177138OtherRAILROAD MEDICARE
TX86383QOtherBLUE CROSS
TX88320HMedicare ID - Type Unspecified