Provider Demographics
NPI:1619203288
Name:PURKIS, ELISABETH A (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ELISABETH
Middle Name:A
Last Name:PURKIS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S. PAULINA ST
Mailing Address - Street 2:230-CB (MC 850)
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-7211
Mailing Address - Country:US
Mailing Address - Phone:312-355-0527
Mailing Address - Fax:312-413-1638
Practice Address - Street 1:801 S PAULINA ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-355-0527
Practice Address - Fax:312-413-1638
Is Sole Proprietor?:No
Enumeration Date:2009-11-02
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490098691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical