Healthcare Provider Details

I. General information

NPI: 1013460492
Provider Name (Legal Business Name): BRIZEL TRINIDAD PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2016
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 RANDALL RD STE 308
GENEVA IL
60134-4205
US

IV. Provider business mailing address

302 RANDALL RD STE 308
GENEVA IL
60134-4205
US

V. Phone/Fax

Practice location:
  • Phone: 630-933-4056
  • Fax: 630-208-3007
Mailing address:
  • Phone: 630-933-4056
  • Fax: 630-208-3007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number071011353
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: