Provider Demographics
NPI:1184460339
Name:HIDALGO, BRANDEN CHARLES
Entity type:Individual
Prefix:
First Name:BRANDEN
Middle Name:CHARLES
Last Name:HIDALGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 N RED OAK CIR UNIT 4
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE BEACH
Mailing Address - State:IL
Mailing Address - Zip Code:60073-2404
Mailing Address - Country:US
Mailing Address - Phone:815-529-2242
Mailing Address - Fax:
Practice Address - Street 1:770 LAKE COOK RD STE 200
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4920
Practice Address - Country:US
Practice Address - Phone:847-607-9662
Practice Address - Fax:866-208-7391
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health