Provider Demographics
NPI:1487211074
Name:HAWKINS, BETH MARIE (LCSW,MAC,CAADC,CCJP)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:MARIE
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:LCSW,MAC,CAADC,CCJP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2319 PLAINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CREST HILL
Mailing Address - State:IL
Mailing Address - Zip Code:60403-1875
Mailing Address - Country:US
Mailing Address - Phone:815-260-7203
Mailing Address - Fax:
Practice Address - Street 1:2319 PLAINFIELD RD
Practice Address - Street 2:
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60403-1875
Practice Address - Country:US
Practice Address - Phone:815-260-7203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL24915101YA0400X
IL149.0132431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
1457829632OtherAETNA
IL1457829632Medicaid