Provider Demographics
NPI:1528730041
Name:SMITH, ELIZABETH JANE
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JANE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 LIONS DR STE 207
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-3175
Mailing Address - Country:US
Mailing Address - Phone:773-280-7405
Mailing Address - Fax:
Practice Address - Street 1:111 LIONS DR STE 207
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-3175
Practice Address - Country:US
Practice Address - Phone:773-280-7405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-03
Last Update Date:2021-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker