Provider Demographics
NPI:1558385385
Name:BENDICSEN, HAROLD KRISTIAN (LCSW)
Entity type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:KRISTIAN
Last Name:BENDICSEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:579 W. NORTH AVE, #207
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2145
Mailing Address - Country:US
Mailing Address - Phone:630-279-5216
Mailing Address - Fax:
Practice Address - Street 1:579 W. NORTH AVE, #207
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2145
Practice Address - Country:US
Practice Address - Phone:630-335-7833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490003971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical