MEDICARE: DR. PAMELA ANNE BRAND M.A., PSY.D., LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	166000568	IL

General Provider Information

NPI Number	:	1093927873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAMELA ANNE BRAND M.A., PSY.D., LMFT

Provider Business Mailing Address
First Line	:	5516 N LAKEWOOD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-1313
Country	:	US
Telephone Number	:	773-307-0114
Fax Number	:

Provider Business Practice Location Address
First Line	:	5516 N LAKEWOOD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-1313
Country	:	US
Telephone Number	:	773-307-0114
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	12/22/2022

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