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General NPI Number Information
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NPI Number | 1073547204
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Entity Type | Organization
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Legal Business Name | MARY ELLEN BRATU PSYD PC
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 03/09/2012
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Provider Practice Location Address
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Address Line | 1555 N NAPERVILLE WHEATON RD SUITE 104
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City | NAPERVILLE
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State | IL
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Zip | 60563-1557
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Country | US
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Telephone | 630-416-8440
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Fax |
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Provider Business Mailing Address
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Address Line | 32W081 ANDERSON LN
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City | NAPERVILLE
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State | IL
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Zip | 60563-9696
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Country | US
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Telephone | 630-416-8440
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. MARY ELLEN BRATU
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Credential | PSYD
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Telephone | 630-416-8440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 071005052
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License Number State | IL
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