Provider Demographics
NPI:1164504379
Name:NEMETH, BRENDA J (LCSW)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:J
Last Name:NEMETH
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 1:14 BRINK ST
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-4302
Mailing Address - Country:US
Mailing Address - Phone:815-455-6736
Mailing Address - Fax:815-455-9744
Practice Address - Street 1:14 BRINK ST
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-4302
Practice Address - Country:US
Practice Address - Phone:815-455-6736
Practice Address - Fax:815-455-9744
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0005615149OtherBCBS
ILK24747Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER
IL388190Medicare ID - Type UnspecifiedGROUP PROVIDER