Provider Demographics
NPI:1063890325
Name:HOLBROOK, ELIZABETH (LCSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:HOLBROOK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21310 STATE ROUTE 9
Mailing Address - Street 2:
Mailing Address - City:TREMONT
Mailing Address - State:IL
Mailing Address - Zip Code:61568-9252
Mailing Address - Country:US
Mailing Address - Phone:309-347-7148
Mailing Address - Fax:309-925-4241
Practice Address - Street 1:21310 STATE ROUTE 9
Practice Address - Street 2:
Practice Address - City:TREMONT
Practice Address - State:IL
Practice Address - Zip Code:61568-9252
Practice Address - Country:US
Practice Address - Phone:309-347-7148
Practice Address - Fax:309-925-4241
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0121881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical