Provider Demographics
NPI:1700129251
Name:BENDIX, BROOKE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:
Last Name:BENDIX
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 1:2015 N DAMEN AVE
Mailing Address - Street 2:APT. 1R
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-4548
Mailing Address - Country:US
Mailing Address - Phone:248-229-1198
Mailing Address - Fax:
Practice Address - Street 1:25650 OUTER DR
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-2096
Practice Address - Country:US
Practice Address - Phone:313-383-1897
Practice Address - Fax:313-383-6018
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490157161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0962301OtherBCBSM
MI0962301OtherBCBSM