Debra Leigh Bryant, LCSW
Individual provider Active NPI Clinical Social Worker · Roscoe, IL
NPI 1902278112 · NPPES record last updated Oct 27, 2015
Key facts
- NPI
- 1902278112
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 149.001379 (IL)
- Practice address
- 11375 Linden Blossom LN
Roscoe, IL 61073-9425 - Phone
- (815) 914-1484
- NPI assigned
- Oct 27, 2015
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160129000845 | IL | Practitioner - Clinical Social Worker | 1759684491 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149.001379 | IL | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vitae Health Medical Illinois, PLLC | Clinical | Current |
Accepting new patients |
| Cognitive Care Counseling, PLLC | Clinical | Past | Accepting new patients |
Locations
303 E Wacker Dr
Ste 1127
Chicago, IL 60601
Phone (312) 328-2347
2451 W Touhy Ave
Chicago, IL 60645
Phone (312) 593-5599
3450 Oakton St
Ste 300
Skokie, IL 60076
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149.001379 | IL | Yes |
Addresses
Primary practice location
11375 Linden Blossom LN
Roscoe, IL 61073-9425
Mailing address
11375 Linden Blossom LN
Roscoe, IL 61073-9425
Phone (815) 914-1484
Other providers in Roscoe, IL
- Marchele A Bowen
- Mark S Bradel
- Tondalaya M Brainard
- Allison Diane Braswell
- Jennifer Brown
- Alexa Buikema
- Elizabeth Burke
- Cassidy Buss
- Hailey Callahan
- Kimberly Christine Callahan
All providers in Roscoe, IL · Clinical Social Worker in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 27, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.