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General NPI Number Information
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NPI Number | 1518387968
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Entity Type | Individual
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Provider Name | ADRIANA BRODYN M.A, M.A, L.P.C
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Gender | Female
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Dates
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Enumeration Date | 04/24/2014
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Last Update Date | 04/24/2014
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Provider Practice Location Address
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Address Line | 1510 W OLIVE AVE
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City | CHICAGO
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State | IL
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Zip | 60660-4292
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Country | US
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Telephone | 908-358-5802
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Fax |
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Provider Business Mailing Address
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Address Line | 1510 W OLIVE AVE APT 1
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City | CHICAGO
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State | IL
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Zip | 60660-4292
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Country | US
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Telephone | 908-358-5802
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 178.009144
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License Number State | IL
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