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General NPI Number Information
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NPI Number | 1295397669
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Entity Type | Individual
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Provider Name | BRENDA MARIE REAVIS LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/05/2019
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Last Update Date | 05/20/2025
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Provider Practice Location Address
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Address Line | 825 CHICAGO AVE FL 2A
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City | EVANSTON
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State | IL
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Zip | 60202-2375
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Country | US
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Telephone | 312-725-4088
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Fax |
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Provider Business Mailing Address
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Address Line | 155 N MICHIGAN AVE STE 723
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City | CHICAGO
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State | IL
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Zip | 60601-7707
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Country | US
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Telephone | 312-725-4088
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.021279
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 149.021279
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License Number State | IL
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