Provider Demographics
NPI:1669520169
Name:BROWN, LINDA MARY (PSYD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:MARY
Last Name:BROWN
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 1:40142 N RENA AVE
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:IL
Mailing Address - Zip Code:60002-8413
Mailing Address - Country:US
Mailing Address - Phone:847-395-7108
Mailing Address - Fax:
Practice Address - Street 1:40142 N RENA AVE
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:IL
Practice Address - Zip Code:60002-8413
Practice Address - Country:US
Practice Address - Phone:847-395-7108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208607Medicare ID - Type Unspecified