1811193782 NPI number — MR. RICHARD FAIRLIE BRINKLEY LCSW, CAP, NCGC II

Table of content: MR. RICHARD FAIRLIE BRINKLEY LCSW, CAP, NCGC II (NPI 1811193782)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811193782 NPI number — MR. RICHARD FAIRLIE BRINKLEY LCSW, CAP, NCGC II

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRINKLEY
Provider First Name:
RICHARD
Provider Middle Name:
FAIRLIE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW, CAP, NCGC II
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811193782
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:
13761 FOREST LAKE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LARGO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33771-5018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-512-3264
Provider Business Mailing Address Fax Number:
727-536-8040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1101 BELCHER RD S STE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LARGO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33771-3356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-512-3264
Provider Business Practice Location Address Fax Number:
727-536-8040
Provider Enumeration Date:
06/26/2007

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:  SW6527 , 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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