Provider Demographics
NPI:1780456509
Name:BRILL, AVIVA S
Entity type:Individual
Prefix:
First Name:AVIVA
Middle Name:S
Last Name:BRILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 W SUPERIOR ST STE 716
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-8784
Mailing Address - Country:US
Mailing Address - Phone:312-343-4692
Mailing Address - Fax:
Practice Address - Street 1:405 W SUPERIOR ST STE 716
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-8784
Practice Address - Country:US
Practice Address - Phone:312-343-4692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical