Provider Demographics
NPI:1669585626
Name:PANARES, BRENNA L (MSW LCSW)
Entity type:Individual
Prefix:MRS
First Name:BRENNA
Middle Name:L
Last Name:PANARES
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20500 S LA GRANGE RD
Mailing Address - Street 2:SUITE 200 S
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-1356
Mailing Address - Country:US
Mailing Address - Phone:815-806-9300
Mailing Address - Fax:815-806-3076
Practice Address - Street 1:20500 S LA GRANGE RD
Practice Address - Street 2:SUITE 200 S
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1356
Practice Address - Country:US
Practice Address - Phone:815-806-9300
Practice Address - Fax:815-806-3076
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
IL149-0078311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL203337Medicare ID - Type UnspecifiedMEDICARE ID