Provider Demographics
NPI:1053847624
Name:VANDEN BROOK, ERIN (LCSW)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:VANDEN BROOK
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 1:645 N KINGSBURY ST
Mailing Address - Street 2:UNIT 2102
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-6940
Mailing Address - Country:US
Mailing Address - Phone:608-577-8028
Mailing Address - Fax:
Practice Address - Street 1:645 N KINGSBURY ST
Practice Address - Street 2:UNIT 2102
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-6940
Practice Address - Country:US
Practice Address - Phone:608-577-8028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490187311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical