Provider Demographics
NPI:1801366802
Name:HAILEY-SMITH, ELIZABETH (LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:HAILEY-SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8540 S OGLESBY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-2308
Mailing Address - Country:US
Mailing Address - Phone:312-206-9363
Mailing Address - Fax:773-437-5427
Practice Address - Street 1:8540 S OGLESBY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-2308
Practice Address - Country:US
Practice Address - Phone:312-206-9363
Practice Address - Fax:773-437-5427
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-03
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149026402101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty