Provider Demographics
NPI:1578808572
Name:BRINKWORTH, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BRINKWORTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 ARBOR CIR
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-3120
Mailing Address - Country:US
Mailing Address - Phone:908-350-7139
Mailing Address - Fax:
Practice Address - Street 1:157 ARBOR CIR
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-3120
Practice Address - Country:US
Practice Address - Phone:908-350-7139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-01
Last Update Date:2012-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst