Provider Demographics
NPI:1134560576
Name:EINERSON, LIESL (LCSW)
Entity type:Individual
Prefix:
First Name:LIESL
Middle Name:
Last Name:EINERSON
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 1:2049 RIDGE AVE
Mailing Address - Street 2:THE CRADLE
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-2713
Mailing Address - Country:US
Mailing Address - Phone:847-733-3215
Mailing Address - Fax:847-475-5871
Practice Address - Street 1:2049 RIDGE AVE
Practice Address - Street 2:THE CRADLE
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-2713
Practice Address - Country:US
Practice Address - Phone:847-733-3215
Practice Address - Fax:847-475-5871
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0147591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical