Provider Demographics
NPI:1174510176
Name:BRICK, ROBERT HENRY (ED D)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:HENRY
Last Name:BRICK
Suffix:
Gender:M
Credentials:ED D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5210 LINTON BLVD.
Mailing Address - Street 2:SUITE 204
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6537
Mailing Address - Country:US
Mailing Address - Phone:561-638-3839
Mailing Address - Fax:561-638-3379
Practice Address - Street 1:5210 LINTON BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6542
Practice Address - Country:US
Practice Address - Phone:561-638-3839
Practice Address - Fax:561-638-3379
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS4764 L103G00000X, 103TC0700X
FLPY3985103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PABR537456Medicare ID - Type Unspecified