Provider Demographics
NPI:1750374757
Name:CLEARBROOK
Entity type:Organization
Organization Name:CLEARBROOK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DEVITO
Authorized Official - Suffix:
Authorized Official - Credentials:MS,LCPC
Authorized Official - Phone:847-392-2812
Mailing Address - Street 1:1835 W CENTRAL RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2410
Mailing Address - Country:US
Mailing Address - Phone:847-392-2812
Mailing Address - Fax:847-392-8939
Practice Address - Street 1:3705 PHEASANT DR
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-2634
Practice Address - Country:US
Practice Address - Phone:847-392-2812
Practice Address - Fax:847-392-8939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1630182OtherBLUE CROSS BLUE SHIELD PR