Active NPI
Lisa Brennan
- Developmental Therapist
- Chicago, IL
National Provider Identifier
1013129733
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmental Therapist
- Practice address
- 4507 N Richmond St
Chicago, IL 60625-3825 - Phone
- (773) 551-8106
- Fax
- (866) 672-5645
- NPI assigned
- May 4, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmental Therapist | 222Q00000X | Primary | ||
| Counselor | 101Y00000X | 178.004881 | IL |
Addresses
Primary practice location
4507 N Richmond St
Chicago, IL 60625-3825
Mailing address
4507 N Richmond St
Chicago, IL 60625-3825
Phone (773) 551-8106
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 178.004881 | IL | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178236800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1239926400000",
"number": "1013129733",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4507 N RICHMOND ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606253825",
"telephone_number": "773-551-8106",
"fax_number": "866-672-5645"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4507 N RICHMOND ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606253825",
"telephone_number": "773-551-8106",
"fax_number": "866-672-5645"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRENNAN",
"first_name": "LISA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-04",
"last_updated": "2009-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": null,
"license": null,
"primary": true
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "IL",
"license": "178.004881",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.