MEDICARE: DR. CONSTANCE S BRAININ PH.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	101YM0800X	Mental Health Counselor	180-000115	IL

General Provider Information

NPI Number	:	1699737569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CONSTANCE S BRAININ PH.D.

Provider Business Mailing Address
First Line	:	5330 W DEVON AVE
Second Line	:	EDGEBROOK MEDICAL BUILDING
City	:	CHICAGO
State	:	IL
Zip	:	60646-4108
Country	:	US
Telephone Number	:	773-775-3133
Fax Number	:

Provider Business Practice Location Address
First Line	:	5330 W DEVON AVE
Second Line	:	EDGEBROOK MEDICAL BUILDING
City	:	CHICAGO
State	:	IL
Zip	:	60646-4108
Country	:	US
Telephone Number	:	773-775-3133
Fax Number	:

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

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	08/31/2009

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