Provider Demographics
NPI:1447092689
Name:KANE, BRIDGET (LCSW)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:KANE
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 1:2771 W FRANCIS PL UNIT 102N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-9534
Mailing Address - Country:US
Mailing Address - Phone:312-404-1343
Mailing Address - Fax:
Practice Address - Street 1:2771 W FRANCIS PL UNIT 102N
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-9534
Practice Address - Country:US
Practice Address - Phone:312-404-1343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0246301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical