Healthcare Provider Details

I. General information

NPI: 1073042263
Provider Name (Legal Business Name): DINA BRACHA VINITSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2017
Last Update Date: 07/25/2021
Certification Date: 07/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1657 W CORTLAND ST # 2S2B
CHICAGO IL
60622-1119
US

IV. Provider business mailing address

2848 W LUNT AVE
CHICAGO IL
60645-2918
US

V. Phone/Fax

Practice location:
  • Phone: 847-414-4140
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-49033
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: