Provider Demographics
NPI:1073950564
Name:SORENSEN, BRIANNA (LCSW, PC)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:SORENSEN
Suffix:
Gender:F
Credentials:LCSW, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4247 N DAMEN AVE # 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-3011
Mailing Address - Country:US
Mailing Address - Phone:630-740-3180
Mailing Address - Fax:
Practice Address - Street 1:4247 N DAMEN AVE # 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3011
Practice Address - Country:US
Practice Address - Phone:630-740-3180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-24
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150013963104100000X
IL1490167171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL150013963OtherLCSW