Provider Demographics
NPI:1033711593
Name:BRONSON, ALISON K (LCSW)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:K
Last Name:BRONSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3512 N SOUTHPORT AVE APT 3S
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-1631
Mailing Address - Country:US
Mailing Address - Phone:248-535-5304
Mailing Address - Fax:
Practice Address - Street 1:3512 N SOUTHPORT AVE APT 3S
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-1631
Practice Address - Country:US
Practice Address - Phone:248-535-5304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0184831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical