Provider Demographics
NPI:1235435066
Name:BRIMBERG, DAVIS K (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVIS
Middle Name:K
Last Name:BRIMBERG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 CERRILLOS RD STE 719D
Mailing Address - Street 2:SUITE #719D
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-2699
Mailing Address - Country:US
Mailing Address - Phone:505-984-3156
Mailing Address - Fax:
Practice Address - Street 1:3600 CERRILLOS RD STE 719D
Practice Address - Street 2:SUITE #719D
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-2699
Practice Address - Country:US
Practice Address - Phone:505-984-3156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPSY 1158103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist