Provider Demographics
NPI:1891041091
Name:AVELLONE, CLAIRE HANLEY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CLAIRE
Middle Name:HANLEY
Last Name:AVELLONE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CLAIRE
Other - Middle Name:MARIE
Other - Last Name:HANLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4350 N BROADWAY ST APT 803
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-4864
Mailing Address - Country:US
Mailing Address - Phone:607-351-4328
Mailing Address - Fax:
Practice Address - Street 1:4350 N BROADWAY ST APT 803
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-4864
Practice Address - Country:US
Practice Address - Phone:607-351-4328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-25
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490149341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical