Provider Demographics
NPI:1588370449
Name:GROSSBLATT, BROOKE V
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:V
Last Name:GROSSBLATT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 WINNETKA AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-4206
Mailing Address - Country:US
Mailing Address - Phone:773-492-4827
Mailing Address - Fax:
Practice Address - Street 1:460 WINNETKA AVE STE 4
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093-4206
Practice Address - Country:US
Practice Address - Phone:773-492-4827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health