Provider Demographics
NPI:1366429508
Name:MEYER, ELAINE CAROL (LCSW)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:CAROL
Last Name:MEYER
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 1:645 S ROGERS ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-2353
Mailing Address - Country:US
Mailing Address - Phone:812-339-1691
Mailing Address - Fax:812-337-2438
Practice Address - Street 1:35 BOB BABBS DR
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IN
Practice Address - Zip Code:47460-6828
Practice Address - Country:US
Practice Address - Phone:812-829-4871
Practice Address - Fax:812-829-0758
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004449A1041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN562970FFMedicare ID - Type Unspecified
000000216748OtherANTHEM
IN546470QQMedicare ID - Type Unspecified