Provider Demographics
NPI:1184906687
Name:BREEN, RYAN JOSEPH (LCPC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:JOSEPH
Last Name:BREEN
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 W MELROSE ST APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-6318
Mailing Address - Country:US
Mailing Address - Phone:773-609-3775
Mailing Address - Fax:
Practice Address - Street 1:2316 W MELROSE ST APT 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-6318
Practice Address - Country:US
Practice Address - Phone:773-609-3775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007947101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
12289219OtherCAQH PROVIDER ID