Provider Demographics
NPI:1720872641
Name:BARRY, BRANDY
Entity type:Individual
Prefix:MISS
First Name:BRANDY
Middle Name:
Last Name:BARRY
Suffix:
Gender:
Credentials:
Other - Prefix:MISS
Other - First Name:BRANDY
Other - Middle Name:
Other - Last Name:BARRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15048 KILDARE AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:IL
Mailing Address - Zip Code:60445-3342
Mailing Address - Country:US
Mailing Address - Phone:773-454-9009
Mailing Address - Fax:
Practice Address - Street 1:15048 KILDARE AVE
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:IL
Practice Address - Zip Code:60445-3342
Practice Address - Country:US
Practice Address - Phone:773-454-9009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health