Provider Demographics
NPI:1013951052
Name:ELKINS, ETHEL A (LCSW)
Entity Type:Individual
Prefix:
First Name:ETHEL
Middle Name:A
Last Name:ELKINS
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 1:9201 FISCHER RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47720-7143
Mailing Address - Country:US
Mailing Address - Phone:812-963-6517
Mailing Address - Fax:
Practice Address - Street 1:5040 S PLAZA DR
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-3066
Practice Address - Country:US
Practice Address - Phone:812-853-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002277A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000381376OtherANTHEM PIN
IN145810LMedicare ID - Type Unspecified
IN000000381376OtherANTHEM PIN