Provider Demographics
NPI:1912434366
Name:BURIAN, MELISSA ELIZABETH (LCSW, CADC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ELIZABETH
Last Name:BURIAN
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1949 MISTY RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60503-7333
Mailing Address - Country:US
Mailing Address - Phone:815-474-8872
Mailing Address - Fax:
Practice Address - Street 1:143 FIRST ST STE 201
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-3102
Practice Address - Country:US
Practice Address - Phone:815-474-8872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-16
Last Update Date:2017-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL32030101YA0400X
IL1490192121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty