Provider Demographics
NPI:1528182920
Name:PETER R. BROWN, PSY,D,
Entity Type:Organization
Organization Name:PETER R. BROWN, PSY,D,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:R
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:708-646-8070
Mailing Address - Street 1:717 STONEBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-1094
Mailing Address - Country:US
Mailing Address - Phone:708-646-8070
Mailing Address - Fax:815-464-9737
Practice Address - Street 1:9601 W. 165TH STREET
Practice Address - Street 2:SUITE 6
Practice Address - City:ORKAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467
Practice Address - Country:US
Practice Address - Phone:708-646-8070
Practice Address - Fax:815-464-9737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL93147Medicare UPIN