NPIMap

Organization Active NPI

Brain and Psychology LLC

  • Clinical Psychologist
  • Skokie, IL
National Provider Identifier
1124424569
Registry record updated Nov 12, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071008790 Issued in IL
Legal business name
BRAIN AND PSYCHOLOGY LLC
Practice address
4711 Golf Rd
Suite 400
Skokie, IL 60076-1224
Phone
(312) 467-2257
Fax
(773) 751-2250
NPI assigned
Nov 12, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Anna Mazur Mosiewicz, PHD
Title
President
Phone
(312) 467-2257

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X 071008790 IL Primary

Addresses

Primary practice location

4711 Golf Rd
Suite 400
Skokie, IL 60076-1224

Mailing address

4711 Golf Rd
Suite 400
Skokie, IL 60076-1224
Phone (312) 467-2257

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1415750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415750400000",
    "number": "1124424569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4711 GOLF RD",
            "address_2": "SUITE 400",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600761224",
            "telephone_number": "312-467-2257",
            "fax_number": "773-751-2250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4711 GOLF RD",
            "address_2": "SUITE 400",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600761224",
            "telephone_number": "312-467-2257",
            "fax_number": "773-751-2250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAIN AND PSYCHOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-12",
        "last_updated": "2014-11-12",
        "status": "A",
        "authorized_official_last_name": "MAZUR MOSIEWICZ",
        "authorized_official_first_name": "ANNA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "312-467-2257",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071008790",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Skokie, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.