| Synchrony Brain Health Llc | |
|
1560 Sherman Ave # 440 Evanston IL 60201-4818 | |
| (866) 362-2300 | |
| (847) 869-1515 |
| Full Name | Synchrony Brain Health Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1560 Sherman Ave # 440, Evanston, Illinois |
| Authorized Official Name and Position | Michelle Forrester (MANAGER) |
| Authorized Official Contact | 9737400023 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Synchrony Brain Health Llc 1560 Sherman Ave # 440 Evanston IL 60201-4818 Ph: () - | Synchrony Brain Health Llc 1560 Sherman Ave # 440 Evanston IL 60201-4818 Ph: (866) 362-2300 |
| NPI Number | 1053900779 |
|---|---|
| Provider Enumeration Date | 01/16/2021 |
| Last Update Date | 08/22/2023 |
| Certification Date | 08/10/2023 |
| Medicare PECOS PAC ID | 7012362288 |
|---|---|
| Medicare Enrollment ID | O20231006003140 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053900779 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Jesse L. Viner |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1427150960 PECOS PAC ID: 9830544006 Enrollment ID: I20231006003181 |
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