Provider Demographics
NPI:1508318171
Name:BRINN, EVAN (PHD)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:BRINN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:EVAN
Other - Middle Name:
Other - Last Name:LASKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:3805 STATE ROUTE 33
Mailing Address - Street 2:APT. 39
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753
Mailing Address - Country:US
Mailing Address - Phone:718-667-2576
Mailing Address - Fax:718-667-2424
Practice Address - Street 1:3805 STATE ROUTE 33
Practice Address - Street 2:APT. 39
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-3260
Practice Address - Country:US
Practice Address - Phone:718-667-2576
Practice Address - Fax:718-667-2424
Is Sole Proprietor?:No
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008604103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical