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NPI Code Detail

MEDICARE: DR. CAROLINE ROSE LAVELOCK BRATNEY PHD

MEDICARE: DR. CAROLINE ROSE LAVELOCK BRATNEY PHD
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 Psychologist071009668IL

General Provider Information

NPI Number : 1457178824
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CAROLINE ROSE LAVELOCK BRATNEY PHD
Provider Business Mailing Address
First Line : 1417 W HURON ST APT 1W
Second Line :
City : CHICAGO
State : IL
Zip : 60642-6171
Country : US
Telephone Number : 816-694-3804
Fax Number :
Provider Business Practice Location Address
First Line : 1200 W HARRISON ST STE 2010
Second Line :
City : CHICAGO
State : IL
Zip : 60607-3320
Country : US
Telephone Number : 312-996-3490
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2024
Last Update Date : 09/25/2024

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