Provider Demographics
NPI:1669431821
Name:DWYER-ELIAS, REBECCA RUTH (LCSW)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:RUTH
Last Name:DWYER-ELIAS
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 1:1800 3RD AVE
Mailing Address - Street 2:SUITE 516
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201
Mailing Address - Country:US
Mailing Address - Phone:309-788-1050
Mailing Address - Fax:
Practice Address - Street 1:1800 3RD AVE
Practice Address - Street 2:SUITE 516
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201
Practice Address - Country:US
Practice Address - Phone:309-788-1050
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0553453Medicaid
IL709850Medicare ID - Type Unspecified