Provider Demographics
NPI:1518087691
Name:BROWN, EDEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:EDEN
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 N ASTOR ST APT 4C
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-1666
Mailing Address - Country:US
Mailing Address - Phone:571-259-9718
Mailing Address - Fax:
Practice Address - Street 1:1430 N ASTOR ST APT 4C
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-1666
Practice Address - Country:US
Practice Address - Phone:571-259-9718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0812-002442103TC0700X
VA0810-02442103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG00588Medicare ID - Type Unspecified