Provider Demographics
NPI:1578706479
Name:LARA, ELBA IRIS (MSW, CADC)
Entity Type:Individual
Prefix:MRS
First Name:ELBA
Middle Name:IRIS
Last Name:LARA
Suffix:
Gender:F
Credentials:MSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 N. KEDZIE AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60651-4152
Mailing Address - Country:US
Mailing Address - Phone:773-772-8009
Mailing Address - Fax:773-292-5490
Practice Address - Street 1:1116 N KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60651-4152
Practice Address - Country:US
Practice Address - Phone:773-772-8009
Practice Address - Fax:773-292-5490
Is Sole Proprietor?:No
Enumeration Date:2009-04-08
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program