Provider Demographics
NPI:1467134114
Name:WRIGHT, BROOKLYN MADISON (RBT)
Entity Type:Individual
Prefix:
First Name:BROOKLYN
Middle Name:MADISON
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 CRICKET LN APT 1B
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-9293
Mailing Address - Country:US
Mailing Address - Phone:270-370-6951
Mailing Address - Fax:
Practice Address - Street 1:156 CRICKET LN APT 1B
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-9293
Practice Address - Country:US
Practice Address - Phone:270-370-6951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-23-257559106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty