Provider Demographics
NPI:1649862566
Name:ANTIN, ELAINE A (LCSW)
Entity type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:A
Last Name:ANTIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:A
Other - Last Name:ANTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:3059 N WEIL ST UNIT 107
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-2281
Mailing Address - Country:US
Mailing Address - Phone:414-278-0167
Mailing Address - Fax:414-278-0167
Practice Address - Street 1:3059 N WEIL ST UNIT 107
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-2281
Practice Address - Country:US
Practice Address - Phone:414-278-0167
Practice Address - Fax:414-278-0167
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI980-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty