Provider Demographics
NPI:1770950503
Name:ROBACK, BRITTANY M (LCPC)
Entity type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:M
Last Name:ROBACK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MISS
Other - First Name:BRITTANY
Other - Middle Name:M
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:106 S LINCOLNWAY
Mailing Address - Street 2:SUITE F
Mailing Address - City:NORTH AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60542-1663
Mailing Address - Country:US
Mailing Address - Phone:630-801-1669
Mailing Address - Fax:630-801-1675
Practice Address - Street 1:106 S LINCOLNWAY
Practice Address - Street 2:SUITE F
Practice Address - City:NORTH AURORA
Practice Address - State:IL
Practice Address - Zip Code:60542-1663
Practice Address - Country:US
Practice Address - Phone:630-801-1669
Practice Address - Fax:630-801-1675
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-27
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.010334101YM0800X
IL180.010312101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health