Provider Demographics
NPI:1992076061
Name:BRISEBOIS, DEBORAH MARIE (LCSW, LMHP, MSW)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:MARIE
Last Name:BRISEBOIS
Suffix:
Gender:F
Credentials:LCSW, LMHP, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 APPALOOSA CT
Mailing Address - Street 2:
Mailing Address - City:SLEEPY HOLLOW
Mailing Address - State:IL
Mailing Address - Zip Code:60118-2517
Mailing Address - Country:US
Mailing Address - Phone:847-687-4361
Mailing Address - Fax:
Practice Address - Street 1:2295 VALLEY CREEK DR STE I
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-2694
Practice Address - Country:US
Practice Address - Phone:847-687-4361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-22
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 171400000X, 171M00000X, 101YA0400X
IL149.0163611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171400000XOther Service ProvidersHealth & Wellness Coach
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)