Provider Demographics
NPI:1508519950
Name:NORTON, BRADEN G (LCSW)
Entity Type:Individual
Prefix:
First Name:BRADEN
Middle Name:G
Last Name:NORTON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S MULFORD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-3012
Mailing Address - Country:US
Mailing Address - Phone:815-399-5700
Mailing Address - Fax:815-399-5767
Practice Address - Street 1:415 S MULFORD RD STE 100
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-3012
Practice Address - Country:US
Practice Address - Phone:815-399-5700
Practice Address - Fax:815-399-5767
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0241991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical