Provider Demographics
NPI:1194840645
Name:FLEMING, ELAINE R (LCSW)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:R
Last Name:FLEMING
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 S MITCHELL AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-3905
Mailing Address - Country:US
Mailing Address - Phone:630-363-8311
Mailing Address - Fax:
Practice Address - Street 1:116 S. YORK ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126
Practice Address - Country:US
Practice Address - Phone:630-363-8311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14900010011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL00002205954OtherBLUE CROSS BLUE SHIELD