Provider Demographics
NPI:1851842330
Name:BENNETT, NIKOLE R (LCSW)
Entity type:Individual
Prefix:MRS
First Name:NIKOLE
Middle Name:R
Last Name:BENNETT
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 1:451 N WESTERN AVE
Mailing Address - Street 2:3
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-1419
Mailing Address - Country:US
Mailing Address - Phone:913-522-9726
Mailing Address - Fax:
Practice Address - Street 1:451 N WESTERN AVE
Practice Address - Street 2:3
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-1419
Practice Address - Country:US
Practice Address - Phone:913-522-9726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0185871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical