Basic Information
| Provider Information | |||||||||
| NPI: | 1457750887 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRINKMAN | ||||||||
| FirstName: | SCOTT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 868 OLD SPRING RD | ||||||||
| Address2: | |||||||||
| City: | COPLEY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443211417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306204025 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8227 BRECKSVILLE RD | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | BRECKSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441411370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4405260468 | ||||||||
| FaxNumber: | 4405260454 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2014 | ||||||||
| LastUpdateDate: | 08/21/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | S 080050018 | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.