Provider Demographics
NPI:1982182945
Name:LAKE, ELIZABETH CEATA (LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CEATA
Last Name:LAKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 WIND SONG DR
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-0683
Mailing Address - Country:US
Mailing Address - Phone:815-302-8814
Mailing Address - Fax:
Practice Address - Street 1:1415 BOND ST STE 127
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-2769
Practice Address - Country:US
Practice Address - Phone:630-355-9002
Practice Address - Fax:630-355-9012
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490201881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty