Provider Demographics
NPI:1467109843
Name:BRICKNER, BRIANNA LEE (MA)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:LEE
Last Name:BRICKNER
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 1:35 HODGDON WAY UNIT 1211
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4295
Mailing Address - Country:US
Mailing Address - Phone:715-828-5606
Mailing Address - Fax:
Practice Address - Street 1:200 INTERNATIONAL DR STE 159
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-6833
Practice Address - Country:US
Practice Address - Phone:715-828-5606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist