Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 071.008955 | IL |
Y | 103T00000X | Psychologist | 071.008955 | IL |
N | 103G00000X | Clinical Psychologist | 020262-1 | NY |
N | 103TC0700X | Clinical Psychologist | 020262-1 | NY |
NPI | 1013345636 |
---|---|
Provider Name | Dr. Brian Sheehan Brown |
First Address | Chicago, IL 60615-4557 |
Second Address | Chicago, IL 60615-4557 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2013 |
Last Update Date | 20/02/2015 |