Provider Demographics
NPI:1770700924
Name:ELIACIN, AMY MICHELLE (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MICHELLE
Last Name:ELIACIN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:BANNOCKBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60015-1265
Mailing Address - Country:US
Mailing Address - Phone:224-268-0026
Mailing Address - Fax:
Practice Address - Street 1:2215 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:BANNOCKBURN
Practice Address - State:IL
Practice Address - Zip Code:60015-1265
Practice Address - Country:US
Practice Address - Phone:224-268-0026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490124141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical