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NPI Code Detail

MEDICARE: MR. BRIAN ETHAN BARUCK LPC

MEDICARE: MR. BRIAN ETHAN BARUCK LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor178.022736IL

General Provider Information

NPI Number : 1154271591
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRIAN ETHAN BARUCK LPC
Provider Business Mailing Address
First Line : 910 SKOKIE BLVD STE 215
Second Line :
City : NORTHBROOK
State : IL
Zip : 60062-4033
Country : US
Telephone Number : 847-480-0300
Fax Number :
Provider Business Practice Location Address
First Line : 910 SKOKIE BLVD STE 215
Second Line :
City : NORTHBROOK
State : IL
Zip : 60062-4033
Country : US
Telephone Number : 847-480-0300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2026
Last Update Date : 02/03/2026

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