Brenna Bourke, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.017804 Issued in IL

Practice address

1718 Sherman Ave Ste 210
Evanston, IL 60201-5610

Phone

(847) 577-1501

Fax

(847) 577-3858

NPI assigned

Dec 6, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lake Cook Psychologists and Counseling AssociatesGroup PAC ID 4183638943, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lake-Cook Psychologists and Counseling Associates

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Arlington Heights, IL
  • NPI 1609975234

  IL

  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1544054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554854400000",
    "number": "1578034245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1112 N HOYNE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606223620",
            "telephone_number": "708-721-1288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1718 SHERMAN AVE STE 210",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602015610",
            "telephone_number": "847-577-1501",
            "fax_number": "847-577-3858"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3345 N Arlington Heights Rd Ste E",
            "address_purpose": "LOCATION",
            "city": "Arlington Heights",
            "state": "IL",
            "postal_code": "600041591",
            "country_code": "US",
            "telephone_number": "847-577-1501",
            "fax_number": "847-577-3858",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1731 N Marcey St Ste 535",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606147965",
            "country_code": "US",
            "telephone_number": "312-280-1166",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOURKE",
        "first_name": "BRENNA",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-12-06",
        "last_updated": "2019-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.017804",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Josephine Bostic, NP
• Jennifer Bosworth, LPC
• Nina Botto, M.D.
• Kevin Boubouleix, MD
• Justin Boumstein, PT, DPT
• Christina Boutsicaris, MD
• Julia Marie Bove, LMFT
• Adeniji Bowden, DDS
• Bowdental
• Natasha Ann Bowen, M.D.

• All providers in Evanston, IL
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.