Provider Demographics
NPI:1053311217
Name:BRINK, BARRY R (PHD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:R
Last Name:BRINK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 FAIRWAY RD
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-3412
Mailing Address - Country:US
Mailing Address - Phone:814-231-5250
Mailing Address - Fax:
Practice Address - Street 1:110 RADNOR RD
Practice Address - Street 2:SUITE 101
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-7987
Practice Address - Country:US
Practice Address - Phone:814-867-0670
Practice Address - Fax:814-867-7616
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008801L103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA725241OtherHIGHMARK