Provider Demographics
NPI:1568900926
Name:KIELY, EITHNE MARY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:EITHNE
Middle Name:MARY
Last Name:KIELY
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 1:321 W CALENDAR AVE
Mailing Address - Street 2:APT 3F
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-2307
Mailing Address - Country:US
Mailing Address - Phone:773-383-9051
Mailing Address - Fax:
Practice Address - Street 1:1101 31ST ST STE 105
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-5535
Practice Address - Country:US
Practice Address - Phone:773-383-9051
Practice Address - Fax:630-926-0640
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-06
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490177391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149.017739OtherLCSW