Organization Name: | BRAIN FITNESS INC |
NPI Number: | 1093131609 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GEORGIA D ANDRIANOPOULOS (PSYCHOLOGIST) |
Mailing Address: | 330 E Main St Suite 201 Barrington |
State: | IL US |
Postal Code: | 600103203 |
Phone Number: | 6303888408 |
Fax Number: | 8473640823 |
NPI Enumeration Date: | 03/07/2014 |
NPI Last Update Date: | 03/07/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 180008028 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |