Provider Demographics
NPI:1083881999
Name:BRICK, DEBORAH ERNESTINE (MSOTR/L)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:ERNESTINE
Last Name:BRICK
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:581 POQUONOCK AVE
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-2202
Mailing Address - Country:US
Mailing Address - Phone:860-688-7211
Mailing Address - Fax:
Practice Address - Street 1:581 POQUONOCK AVE
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-2202
Practice Address - Country:US
Practice Address - Phone:860-688-7211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001872174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist