Provider Demographics
NPI:1992039366
Name:BROOKS, ELISE BETH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELISE
Middle Name:BETH
Last Name:BROOKS
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 1:3047 N LINCOLN AVE UNIT 400
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4274
Mailing Address - Country:US
Mailing Address - Phone:773-600-1463
Mailing Address - Fax:
Practice Address - Street 1:3047 N LINCOLN AVE UNIT 400
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-4274
Practice Address - Country:US
Practice Address - Phone:773-600-1463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490062781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical