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General NPI Number Information
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NPI Number | 1154085405
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Entity Type | Organization
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Legal Business Name | BRAVE BEGINNING PSYCHOTHERAPY
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Dates
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Enumeration Date | 10/23/2021
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Last Update Date | 10/23/2021
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Provider Practice Location Address
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Address Line | 4433 W TOUHY AVE STE 500
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City | LINCOLNWOOD
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State | IL
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Zip | 60712-1838
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Country | US
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Telephone | 224-307-6219
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Fax |
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Provider Business Mailing Address
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Address Line | 750 NORTHWEST HWY APT 108
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City | DES PLAINES
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State | IL
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Zip | 60016-3047
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Country | US
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Telephone | 619-246-2179
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. CORINNA MARIE CORREIA
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Credential | PHD
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Telephone | 619-246-2179
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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