Provider Demographics
NPI:1235319054
Name:MCBRIDE, ILENE ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ILENE
Middle Name:ANN
Last Name:MCBRIDE
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 1:131 NORMANDY DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-7476
Mailing Address - Country:US
Mailing Address - Phone:615-773-3520
Mailing Address - Fax:
Practice Address - Street 1:131 NORMANDY DR
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-7476
Practice Address - Country:US
Practice Address - Phone:615-773-3520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000048451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical