Provider Demographics
NPI:1407025398
Name:BRINKMAN, PRISCILLA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PRISCILLA
Middle Name:
Last Name:BRINKMAN
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 1:825 W STATE ST STE 118
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-2078
Mailing Address - Country:US
Mailing Address - Phone:630-471-2117
Mailing Address - Fax:
Practice Address - Street 1:711 SOUTH ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2511
Practice Address - Country:US
Practice Address - Phone:630-471-2117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-25
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0003511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL7126Medicaid