Provider Demographics
NPI:1033422498
Name:BRUCAR, SHELLEY JEAN (LCSW, CADC)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:JEAN
Last Name:BRUCAR
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 LEE ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-4539
Mailing Address - Country:US
Mailing Address - Phone:847-795-3945
Mailing Address - Fax:
Practice Address - Street 1:701 LEE ST
Practice Address - Street 2:SUITE 800
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-4539
Practice Address - Country:US
Practice Address - Phone:847-795-3945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490097141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical