Provider Demographics
NPI:1568608172
Name:NELSON, DEBRA S (LCSW)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:S
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 1:105 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:FOX RIVER GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60021-1401
Mailing Address - Country:US
Mailing Address - Phone:847-373-2874
Mailing Address - Fax:
Practice Address - Street 1:236 W NORTHWEST HWY
Practice Address - Street 2:SUITE 204
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-3195
Practice Address - Country:US
Practice Address - Phone:847-373-2874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-02
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0072521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical