Healthcare Provider Details

I. General information

NPI: 1962927970
Provider Name (Legal Business Name): NICOLE M BARANYAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2017
Last Update Date: 08/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 E CHESTNUT ST 305
CHICAGO IL
60611
US

IV. Provider business mailing address

4865 N MAGNOLIA AVE
CHICAGO IL
60640
US

V. Phone/Fax

Practice location:
  • Phone: 312-787-8425
  • Fax: 203-260-9511
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: