Provider Demographics
NPI:1932221181
Name:PATRICIA ELY AND ASSOCIATES
Entity Type:Organization
Organization Name:PATRICIA ELY AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOCIAL WORKER/CLINICAL DIRECT
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:ELY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW, ACSW
Authorized Official - Phone:630-574-9000
Mailing Address - Street 1:2625 BUTTERFIELD ROAD
Mailing Address - Street 2:SUITE 103W
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523
Mailing Address - Country:US
Mailing Address - Phone:630-574-9000
Mailing Address - Fax:630-574-9277
Practice Address - Street 1:2625 BUTTERFIELD ROAD
Practice Address - Street 2:SUITE 103W
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523
Practice Address - Country:US
Practice Address - Phone:630-574-9000
Practice Address - Fax:630-574-9277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.005969101YM0800X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty