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NPI Code Detail

MEDICARE: MS. ELISE BETH BROOKS LCSW

MEDICARE: MS. ELISE BETH BROOKS 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
11041C0700XClinical Social Worker149006278IL

General Provider Information

NPI Number : 1992039366
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ELISE BETH BROOKS LCSW
Provider Business Mailing Address
First Line : 3047 N LINCOLN AVE UNIT 400
Second Line :
City : CHICAGO
State : IL
Zip : 60657-4274
Country : US
Telephone Number : 773-600-1463
Fax Number :
Provider Business Practice Location Address
First Line : 3047 N LINCOLN AVE UNIT 400
Second Line :
City : CHICAGO
State : IL
Zip : 60657-4274
Country : US
Telephone Number : 773-600-1463
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/01/2009
Last Update Date : 10/01/2009

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