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NPI Code Detail

MEDICARE: HOWARD BROWN HEALTH CENTER

MEDICARE: HOWARD BROWN HEALTH CENTER
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
1103TC0700XClinical PsychologistIL

General Provider Information

NPI Number : 1215917109
Entity Type Code : Organization
Provider Name (Legal Business Name) : HOWARD BROWN HEALTH CENTER
Provider Business Mailing Address
First Line : 720 W GORDON TER
Second Line :
City : CHICAGO
State : IL
Zip : 60613-5700
Country : US
Telephone Number : 773-296-9505
Fax Number :
Provider Business Practice Location Address
First Line : 4025 N SHERIDAN RD
Second Line :
City : CHICAGO
State : IL
Zip : 60613-2010
Country : US
Telephone Number : 773-388-8909
Fax Number :
Authorized Official
Title or Position : CLINICAL PSYCHOLOGIST
Name : EDWARD FAJARDO
Credential :
Telephone Number : 773-388-8909
Provider Enumeration Date : 01/18/2006
Last Update Date : 08/22/2020

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Directions to “HOWARD BROWN HEALTH CENTER ” Practice Location

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