Provider Demographics
NPI:1972623585
Name:FUNG, ELIZABETH H (PHD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:H
Last Name:FUNG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 W WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-3812
Mailing Address - Country:US
Mailing Address - Phone:773-477-0584
Mailing Address - Fax:
Practice Address - Street 1:2524 N LINCOLN AVE
Practice Address - Street 2:LINCOLN PARK PSYCHOLOGICAL ASSOCIATE - SUITE J
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-2473
Practice Address - Country:US
Practice Address - Phone:773-477-0584
Practice Address - Fax:773-477-0584
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0013521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149.001352OtherLCSW