Provider Demographics
NPI:1790581882
Name:BROOKSON, LATIFAH (LSW)
Entity type:Individual
Prefix:
First Name:LATIFAH
Middle Name:
Last Name:BROOKSON
Suffix:
Gender:
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 WESTMORE MEYERS RD APT 203
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-3734
Mailing Address - Country:US
Mailing Address - Phone:708-560-6653
Mailing Address - Fax:
Practice Address - Street 1:55 W 22ND ST STE 305
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-7048
Practice Address - Country:US
Practice Address - Phone:708-640-1862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150114423104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker