Provider Demographics
NPI:1275209397
Name:BRACKEN, MORIAH (LCSW)
Entity Type:Individual
Prefix:
First Name:MORIAH
Middle Name:
Last Name:BRACKEN
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 1:480 SUSAN LN
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-3949
Mailing Address - Country:US
Mailing Address - Phone:847-769-6926
Mailing Address - Fax:
Practice Address - Street 1:480 SUSAN LN
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-3949
Practice Address - Country:US
Practice Address - Phone:847-769-6926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-18
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0234131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical