Provider Demographics
NPI:1437966561
Name:CHARLOTTE MIDDLEBROOK LCSW LLC
Entity type:Organization
Organization Name:CHARLOTTE MIDDLEBROOK LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:MIDDLEBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:CCM, MSW, LCSW
Authorized Official - Phone:513-312-9761
Mailing Address - Street 1:719 HOME AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-1013
Mailing Address - Country:US
Mailing Address - Phone:513-312-9761
Mailing Address - Fax:
Practice Address - Street 1:719 HOME AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-1013
Practice Address - Country:US
Practice Address - Phone:513-312-9761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty