Organization
BRENDA BLACK LCSW PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BRENDA N BLACK LCSW PC (OWNER)
(312) 718-6996
Entity
Organization
Contact information
Practice address
717 MAIN ST, SUITE 2E, EVANSTON, IL 60202-1701
(312) 718-6996
Mailing address
717 MAIN ST, SUITE 2E, EVANSTON, IL 60202-1701
(312) 718-6996
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149013929
IL
Other
Enumeration date
06/30/2010
Last updated
06/23/2011
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