1417391061 NPI number — MARIA VITTORIA BRICKLEY MA, NCSP

Table of content: MARIA VITTORIA BRICKLEY MA, NCSP (NPI 1417391061)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417391061 NPI number — MARIA VITTORIA BRICKLEY MA, NCSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRICKLEY
Provider First Name:
MARIA
Provider Middle Name:
VITTORIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, NCSP
Provider Gender Code:
F

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:
1417391061
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8227 CLOVERLEAF DR
Provider Second Line Business Mailing Address:
SUITE 303
Provider Business Mailing Address City Name:
MILLERSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21108-1565
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-292-0016
Provider Business Mailing Address Fax Number:
888-224-0984

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8227 CLOVERLEAF DR
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
MILLERSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21108-1565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-292-0016
Provider Business Practice Location Address Fax Number:
888-224-0984
Provider Enumeration Date:
04/25/2013

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: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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