Provider Demographics
NPI:1932203569
Name:CLEVELAND, ELNORA G
Entity Type:Individual
Prefix:MS
First Name:ELNORA
Middle Name:G
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ELNORA
Other - Middle Name:G
Other - Last Name:CLEVELAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:3529 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46408-1545
Mailing Address - Country:US
Mailing Address - Phone:219-980-4669
Mailing Address - Fax:
Practice Address - Street 1:3529 PIERCE ST
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46408-1545
Practice Address - Country:US
Practice Address - Phone:219-980-4669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN340017351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical