Provider Demographics
NPI:1881014496
Name:VANESSA BRADDEN, LMFT, P.C.
Entity Type:Organization
Organization Name:VANESSA BRADDEN, LMFT, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:773-998-1220
Mailing Address - Street 1:3166 N LINCOLN AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3133
Mailing Address - Country:US
Mailing Address - Phone:773-998-1220
Mailing Address - Fax:
Practice Address - Street 1:3166 N LINCOLN AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3133
Practice Address - Country:US
Practice Address - Phone:773-998-1220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166000731305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization