Provider Demographics
NPI:1013712066
Name:ALLEN, BRENDA (LCSW LSW CADC)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LCSW LSW CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7024 S PERRY AVE APT 2C
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60621-3647
Mailing Address - Country:US
Mailing Address - Phone:773-895-5011
Mailing Address - Fax:
Practice Address - Street 1:7024 S PERRY AVE APT 2C
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-3647
Practice Address - Country:US
Practice Address - Phone:773-895-5011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL30371101YA0400X
IL149.0266091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)