Provider Demographics
NPI:1750893376
Name:BROWN, TIFFANY (PSYD, CAMS-II)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:PSYD, CAMS-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9522 S HALSTED ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-1028
Mailing Address - Country:US
Mailing Address - Phone:773-595-5794
Mailing Address - Fax:
Practice Address - Street 1:9522 S HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-1028
Practice Address - Country:US
Practice Address - Phone:773-595-5794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-05
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X, 103TF0200X
IL071011395103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic