Provider Demographics
NPI:1013460492
Name:TRINIDAD, BRIZEL (PSYD)
Entity type:Individual
Prefix:
First Name:BRIZEL
Middle Name:
Last Name:TRINIDAD
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 1:302 RANDALL RD STE 308
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4205
Mailing Address - Country:US
Mailing Address - Phone:630-933-4056
Mailing Address - Fax:630-208-3007
Practice Address - Street 1:302 RANDALL RD STE 308
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4205
Practice Address - Country:US
Practice Address - Phone:630-933-4056
Practice Address - Fax:630-208-3007
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
IL071011353103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst