Provider Demographics
NPI:1336134949
Name:BRIGHAM, KAROL SOLOMON (PHD)
Entity Type:Individual
Prefix:
First Name:KAROL
Middle Name:SOLOMON
Last Name:BRIGHAM
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 1:1615 VILLAGE SQUARE BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-2770
Mailing Address - Country:US
Mailing Address - Phone:850-224-4442
Mailing Address - Fax:850-574-6030
Practice Address - Street 1:1003 N ADAMS ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-6132
Practice Address - Country:US
Practice Address - Phone:850-224-4442
Practice Address - Fax:850-574-6030
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3059103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73761OtherBLUE CROSS/BLUE SHIELD
FL73761BMedicare ID - Type UnspecifiedMEDICARE