Provider Demographics
NPI:1700940095
Name:LENNIHAN, ELIZABETH M (MA)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:M
Last Name:LENNIHAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:L
Other - Last Name:TSORIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:30 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 816
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3402
Mailing Address - Country:US
Mailing Address - Phone:312-551-0540
Mailing Address - Fax:847-251-5211
Practice Address - Street 1:30 N MICHIGAN AVE
Practice Address - Street 2:SUITE 816
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3402
Practice Address - Country:US
Practice Address - Phone:312-551-0540
Practice Address - Fax:847-251-5211
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
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
ILQ56494Medicare ID - Type Unspecified