Provider Demographics
NPI:1104917004
Name:BRANDMAN, PAMELA RITA (LCSW)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:RITA
Last Name:BRANDMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:PAMELA
Other - Middle Name:RITA
Other - Last Name:KERTESZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:246 E JANATA BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5317
Mailing Address - Country:US
Mailing Address - Phone:630-424-8900
Mailing Address - Fax:630-424-9017
Practice Address - Street 1:246 E JANATA BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5317
Practice Address - Country:US
Practice Address - Phone:630-424-8900
Practice Address - Fax:630-424-9017
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK25034Medicare UPIN