Provider Demographics
NPI:1558499731
Name:KING, BRIAN R (LCSW MSW)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:R
Last Name:KING
Suffix:
Gender:M
Credentials:LCSW MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:40 SHUMAN BLVD
Mailing Address - Street 2:SUITE 160 ONE ENERGY CENTER
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563
Mailing Address - Country:US
Mailing Address - Phone:630-778-3447
Mailing Address - Fax:815-828-0941
Practice Address - Street 1:40 SHUMAN BLVD
Practice Address - Street 2:SUITE 160 ONE ENERGY CENTER
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563
Practice Address - Country:US
Practice Address - Phone:630-778-3447
Practice Address - Fax:815-828-0941
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker