Provider Demographics
NPI:1548339633
Name:DOLCE-BROUWER, LYNNE ELLEN (LCSW LICENSED CLINIC)
Entity type:Individual
Prefix:MRS
First Name:LYNNE
Middle Name:ELLEN
Last Name:DOLCE-BROUWER
Suffix:
Gender:F
Credentials:LCSW LICENSED CLINIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 N RACINE AVE
Mailing Address - Street 2:#2100
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-4045
Mailing Address - Country:US
Mailing Address - Phone:773-296-4335
Mailing Address - Fax:773-296-1430
Practice Address - Street 1:2000 N RACINE AVE
Practice Address - Street 2:#2100
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-4045
Practice Address - Country:US
Practice Address - Phone:773-296-4335
Practice Address - Fax:773-296-1430
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01632160OtherBLUE CROSS & BLUE SHIELD
IL200869Medicare ID - Type UnspecifiedPART B