Provider Demographics
NPI:1720333776
Name:BRENNER, STEPHANIE (LCSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:BRENNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:HORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2530 CRAWFORD AVE STE 116
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4954
Mailing Address - Country:US
Mailing Address - Phone:847-497-8374
Mailing Address - Fax:847-996-2134
Practice Address - Street 1:2530 CRAWFORD AVE STE 116
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201
Practice Address - Country:US
Practice Address - Phone:847-497-8374
Practice Address - Fax:847-996-2134
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490153441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical