Provider Demographics
NPI:1407321086
Name:GUEVARA, BRIGID L (EDS)
Entity Type:Individual
Prefix:MRS
First Name:BRIGID
Middle Name:L
Last Name:GUEVARA
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:MS
Other - First Name:BRIGID
Other - Middle Name:L
Other - Last Name:BURFEIND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDS
Mailing Address - Street 1:21701 GOUGAR RD
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-1576
Mailing Address - Country:US
Mailing Address - Phone:815-717-3543
Mailing Address - Fax:
Practice Address - Street 1:21701 GOUGAR RD
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-1576
Practice Address - Country:US
Practice Address - Phone:815-717-3543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool