Provider Demographics
NPI:1225448301
Name:BROWN, STACEY L (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:L
Last Name:BROWN
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 1:820 OAKTON ST
Mailing Address - Street 2:5A
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-2874
Mailing Address - Country:US
Mailing Address - Phone:773-459-3136
Mailing Address - Fax:773-654-3340
Practice Address - Street 1:2152 W FARRAGUT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-1204
Practice Address - Country:US
Practice Address - Phone:773-459-3136
Practice Address - Fax:773-654-3340
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-29
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490103461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical