Healthcare Provider Details

I. General information

NPI: 1003779133
Provider Name (Legal Business Name): BRIANNA MARGO BORRI PSYD.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6640 INTECH BLVD STE 195
INDIANAPOLIS IN
46278-2014
US

IV. Provider business mailing address

PO BOX 719094
CHICAGO IL
60677-9318
US

V. Phone/Fax

Practice location:
  • Phone: 616-301-5933
  • Fax:
Mailing address:
  • Phone: 317-777-6435
  • Fax: 317-777-6644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number20044014A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: