MEDICARE: BRENDA MARIE REAVIS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	149.021279	IL
2	101YM0800X	Mental Health Counselor	149.021279	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295397669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA MARIE REAVIS LCSW

Provider Business Mailing Address
First Line	:	155 N MICHIGAN AVE STE 723
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60601-7707
Country	:	US
Telephone Number	:	312-725-4088
Fax Number	:

Provider Business Practice Location Address
First Line	:	825 CHICAGO AVE FL 2A
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60202-2375
Country	:	US
Telephone Number	:	312-725-4088
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2019
Last Update Date	:	05/20/2025

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