Provider Demographics
NPI:1205348703
Name:CASACLANG-MELO, ELIZABETH (MA, LPC, CADC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:CASACLANG-MELO
Suffix:
Gender:F
Credentials:MA, LPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3976 N AVONDALE AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-2900
Mailing Address - Country:US
Mailing Address - Phone:630-428-7890
Mailing Address - Fax:
Practice Address - Street 1:3976 N AVONDALE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-2900
Practice Address - Country:US
Practice Address - Phone:847-462-6099
Practice Address - Fax:847-628-6064
Is Sole Proprietor?:No
Enumeration Date:2017-10-25
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL30088101YA0400X
IL178.002996101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)