Active NPI
Howard Brown Health Center
- Clinical Psychologist
- Chicago, IL
National Provider Identifier
1215917109
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- Legal business name
- HOWARD BROWN HEALTH CENTER
- Practice address
- 4025 N Sheridan Rd
Chicago, IL 60613-2010 - Phone
- (773) 388-8909
- NPI assigned
- Jan 18, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Edward Fajardo
- Title
- Clinical Psychologist
- Phone
- (773) 388-8909
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | IL | Primary |
Addresses
Primary practice location
4025 N Sheridan Rd
Chicago, IL 60613-2010
Mailing address
720 W Gordon Ter
Chicago, IL 60613-5700
Phone (773) 296-9505
National Provider Directory
National Provider DirectoryLocations
720 W Gordon Ter
Chicago, IL 60613
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137542400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1215917109",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "720 W GORDON TER",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606135700",
"telephone_number": "773-296-9505"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4025 N SHERIDAN RD",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606132010",
"telephone_number": "773-388-8909"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HOWARD BROWN HEALTH CENTER",
"organizational_subpart": "NO",
"enumeration_date": "2006-01-18",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "FAJARDO",
"authorized_official_first_name": "EDWARD",
"authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
"authorized_official_telephone_number": "773-388-8909"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": null,
"primary": true
}
],
"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 Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.