Provider Demographics
NPI:1639538549
Name:WOLFE, ELEANOR (LCSW AND CADC)
Entity Type:Individual
Prefix:MS
First Name:ELEANOR
Middle Name:
Last Name:WOLFE
Suffix:
Gender:F
Credentials:LCSW AND CADC
Other - Prefix:MS
Other - First Name:ELEANOR
Other - Middle Name:
Other - Last Name:WOLFE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW AND CADC
Mailing Address - Street 1:434 W BRIAR PL APT 5
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4700
Mailing Address - Country:US
Mailing Address - Phone:773-322-8254
Mailing Address - Fax:
Practice Address - Street 1:434 W BRIAR PL APT 5
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-4700
Practice Address - Country:US
Practice Address - Phone:773-322-8254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-19
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL24834101YA0400X
IL1490115581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)