Provider Demographics
NPI:1619695657
Name:ADAMCZEWSKA, ELIZA MARIA
Entity Type:Individual
Prefix:
First Name:ELIZA
Middle Name:MARIA
Last Name:ADAMCZEWSKA
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 1:4219 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-2901
Mailing Address - Country:US
Mailing Address - Phone:773-537-3122
Mailing Address - Fax:773-472-2696
Practice Address - Street 1:3951 N MEADE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-2889
Practice Address - Country:US
Practice Address - Phone:773-297-7094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208.001005101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health