| Brenda Black Lcsw Pc | |
|
717 Main St Suite 2e Evanston IL 60202-1701 | |
| (312) 718-6996 | |
| Not Available |
| Full Name | Brenda Black Lcsw Pc |
|---|---|
| Speciality | Social Worker |
| Location | 717 Main St, Evanston, Illinois |
| Authorized Official Name and Position | Brenda N Black (OWNER) |
| Authorized Official Contact | 3127186996 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brenda Black Lcsw Pc 717 Main St Suite 2e Evanston IL 60202-1701 Ph: (312) 718-6996 | Brenda Black Lcsw Pc 717 Main St Suite 2e Evanston IL 60202-1701 Ph: (312) 718-6996 |
| NPI Number | 1265743637 |
|---|---|
| Provider Enumeration Date | 06/30/2010 |
| Last Update Date | 06/23/2011 |
| Medicare PECOS PAC ID | 1254511553 |
|---|---|
| Medicare Enrollment ID | O20110203000393 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265743637 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 149013929 (Illinois) | Primary |
| Provider Name | Brenda N Black |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245554724 PECOS PAC ID: 4385824689 Enrollment ID: I20110203000445 |
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