Provider Demographics
NPI:1710222112
Name:HOLMBERG, BRITON EDWARD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:BRITON
Middle Name:EDWARD
Last Name:HOLMBERG
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 1:5732 N KENMORE AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-6514
Mailing Address - Country:US
Mailing Address - Phone:518-368-0174
Mailing Address - Fax:847-446-6957
Practice Address - Street 1:690 OAK ST
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093-2522
Practice Address - Country:US
Practice Address - Phone:847-446-6955
Practice Address - Fax:847-446-6957
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0153251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical