Provider Demographics
NPI:1477998334
Name:DEFIGLIA, ALINE BETHEA TALMAGE (LCSW/MPH/CADC)
Entity type:Individual
Prefix:
First Name:ALINE
Middle Name:BETHEA TALMAGE
Last Name:DEFIGLIA
Suffix:
Gender:F
Credentials:LCSW/MPH/CADC
Other - Prefix:
Other - First Name:ALINE
Other - Middle Name:BETHEA
Other - Last Name:TALMAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3229 N CENTRAL PARK AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-5305
Mailing Address - Country:US
Mailing Address - Phone:770-894-9693
Mailing Address - Fax:
Practice Address - Street 1:1821 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-2040
Practice Address - Country:US
Practice Address - Phone:773-888-2713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
IL149.0177961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health