Provider Demographics
NPI:1376056200
Name:BRINCKO, JUSTIN JOHN
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:JOHN
Last Name:BRINCKO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5769 UPLANDER WAY
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6605
Mailing Address - Country:US
Mailing Address - Phone:310-337-9800
Mailing Address - Fax:310-337-0400
Practice Address - Street 1:5769 UPLANDER WAY
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6605
Practice Address - Country:US
Practice Address - Phone:310-337-9800
Practice Address - Fax:310-337-0400
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health