Provider Demographics
NPI:1225494842
Name:BRINK, ERIN K R (MA)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:K R
Last Name:BRINK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 W JOHN ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337-1809
Mailing Address - Country:US
Mailing Address - Phone:917-837-0720
Mailing Address - Fax:
Practice Address - Street 1:218 W JOHN ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-1809
Practice Address - Country:US
Practice Address - Phone:917-837-0720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-12
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH001464103K00000X
PAPC013509101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPC013509OtherLPC NUMBER