Provider Demographics
NPI:1053516203
Name:FAMILY STRESS CLINIC
Entity type:Organization
Organization Name:FAMILY STRESS CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:BRICKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DN AM DCSW LCSW
Authorized Official - Phone:773-935-3500
Mailing Address - Street 1:2800 N LAKE SHORE DR
Mailing Address - Street 2:#2215
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6232
Mailing Address - Country:US
Mailing Address - Phone:773-935-3500
Mailing Address - Fax:773-472-1022
Practice Address - Street 1:30 N MICHIGAN AVE
Practice Address - Street 2:#1729
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3402
Practice Address - Country:US
Practice Address - Phone:773-935-3500
Practice Address - Fax:773-472-1022
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLIFFORD BRICKMAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-18
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490005231041C0700X
IL181000295172P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No172P00000XOther Service ProvidersNaprapathGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01617791OtherBLUECROSS-BLUESHIELD #