1790759751 NPI number — MRS. RACHEL LONG BRINK L.C.S.W., B.C.D.

Table of content: LONDON BRAZIL (NPI 1649686239)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790759751 NPI number — MRS. RACHEL LONG BRINK L.C.S.W., B.C.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRINK
Provider First Name:
RACHEL
Provider Middle Name:
LONG
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W., B.C.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COLQUITT
Provider Other First Name:
RACHEL
Provider Other Middle Name:
LONG
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.C.S.W.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1790759751
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3743 EAGLEFLIGHT LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAND O LAKES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34639-4080
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-995-2530
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14517 BRUCE B DOWNS BLVD
Provider Second Line Business Practice Location Address:
SUITE #201
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33613-2755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-228-2761
Provider Business Practice Location Address Fax Number:
813-225-7048
Provider Enumeration Date:
02/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  SW 5706 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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