Provider Demographics
NPI:1700057957
Name:MCGRATH, BREEDA M (PHD, NCSP)
Entity Type:Individual
Prefix:DR
First Name:BREEDA
Middle Name:M
Last Name:MCGRATH
Suffix:
Gender:F
Credentials:PHD, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 N WELLS ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-7024
Mailing Address - Country:US
Mailing Address - Phone:847-778-8681
Mailing Address - Fax:
Practice Address - Street 1:1315 AVE ASHFORD APT 804
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1376
Practice Address - Country:US
Practice Address - Phone:847-778-8681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-16
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.007339103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical