Provider Demographics
NPI:1356685325
Name:NELSON, BRENDA K (LCSW)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:K
Last Name:NELSON
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 1:330 E MAIN ST
Mailing Address - Street 2:#203
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-3203
Mailing Address - Country:US
Mailing Address - Phone:847-567-0413
Mailing Address - Fax:
Practice Address - Street 1:330 E MAIN ST
Practice Address - Street 2:203
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-3203
Practice Address - Country:US
Practice Address - Phone:847-567-0413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490116061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical