Provider Demographics
NPI:1639414394
Name:BREWER, CHARLES DANIEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:DANIEL
Last Name:BREWER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2835 N SHEFFIELD AVE
Mailing Address - Street 2:STE 404
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5081
Mailing Address - Country:US
Mailing Address - Phone:773-413-6006
Mailing Address - Fax:773-880-2242
Practice Address - Street 1:2835 N SHEFFIELD AVE
Practice Address - Street 2:STE 404
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5081
Practice Address - Country:US
Practice Address - Phone:773-413-6006
Practice Address - Fax:773-880-2242
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008477103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical