Provider Demographics
NPI:1457616112
Name:ANDRIE, BRIANNA NIKOLE
Entity type:Individual
Prefix:MISS
First Name:BRIANNA
Middle Name:NIKOLE
Last Name:ANDRIE
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 1:775 W DIVERSEY PKWY APT 3CW
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1590
Mailing Address - Country:US
Mailing Address - Phone:440-983-1318
Mailing Address - Fax:
Practice Address - Street 1:4677 N VIRGINIA AVE
Practice Address - Street 2:1N
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-2953
Practice Address - Country:US
Practice Address - Phone:312-520-4657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst