MEDICARE: DR. NICOLAS BRANDON WARNER PSY.D

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
1	103TC0700X	Clinical Psychologist	071008256	IL

General Provider Information

NPI Number	:	1255608683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLAS BRANDON WARNER PSY.D

Provider Business Mailing Address
First Line	:	4610 N CLARK ST # 1307
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-4620
Country	:	US
Telephone Number	:	773-240-5151
Fax Number	:	341-689-3474

Provider Business Practice Location Address
First Line	:	4610 N CLARK ST # 1307
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-4620
Country	:	US
Telephone Number	:	773-240-5151
Fax Number	:	341-689-3474

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2011
Last Update Date	:	08/02/2024

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