Provider Demographics
NPI:1063638641
Name:BRICKLEY, PATRICIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:BRICKLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 MUCHMORE LN
Mailing Address - Street 2:#2
Mailing Address - City:EAST HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11937-7401
Mailing Address - Country:US
Mailing Address - Phone:631-329-1466
Mailing Address - Fax:631-329-1466
Practice Address - Street 1:7 MUCHMORE LN
Practice Address - Street 2:#2
Practice Address - City:EAST HAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11937-7401
Practice Address - Country:US
Practice Address - Phone:631-329-1466
Practice Address - Fax:631-329-1466
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR036070-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNH5421Medicare ID - Type Unspecified