Provider Demographics
NPI:1548086077
Name:BROTAN, LAUREEN MICHELE (LCSW)
Entity type:Individual
Prefix:
First Name:LAUREEN
Middle Name:MICHELE
Last Name:BROTAN
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 1:8425 OWL CT
Mailing Address - Street 2:
Mailing Address - City:VILLAGE OF LAKEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60014-3323
Mailing Address - Country:US
Mailing Address - Phone:847-707-7220
Mailing Address - Fax:
Practice Address - Street 1:8425 OWL CT
Practice Address - Street 2:
Practice Address - City:VILLAGE OF LAKEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60014-3323
Practice Address - Country:US
Practice Address - Phone:847-707-7220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-30
Last Update Date:2024-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490.154701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical