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General NPI Number Information
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NPI Number | 1093131609
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Entity Type | Organization
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Legal Business Name | BRAIN FITNESS INC
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Dates
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Enumeration Date | 03/07/2014
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Last Update Date | 03/07/2014
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Provider Practice Location Address
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Address Line | 330 E MAIN ST SUITE 201
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City | BARRINGTON
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State | IL
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Zip | 60010-3203
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Country | US
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Telephone | 630-388-8408
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Fax | 847-364-0823
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Provider Business Mailing Address
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Address Line | 191 W GARFIELD AVE
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City | ELMHURST
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State | IL
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Zip | 60126-3901
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Country | US
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Telephone | 630-388-8408
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Fax | 847-364-0823
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. GEORGIA D ANDRIANOPOULOS
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Credential | PHD
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Telephone | 630-388-8408
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180008028
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License Number State | IL
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