Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 071008590 | IL |
Y | 103TC0700X | Clinical Psychologist | 071008590 | IL |
N | 103G00000X | Clinical Psychologist | 071008590 | IL |
N | 103TC0700X | Clinical Psychologist | 071008590 | IL |
NPI | 1003253949 |
---|---|
Provider Name | Dr. Michael Brook |
First Address | Chicago, IL 60611-4418 |
Second Address | Chicago, IL 60611-4418 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2013 |
Last Update Date | 02/06/2013 |