Provider Demographics
NPI:1770673956
Name:BRUMBACK, CATHY J (PHD)
Entity Type:Individual
Prefix:DR
First Name:CATHY
Middle Name:J
Last Name:BRUMBACK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22787 US HIGHWAY 98
Mailing Address - Street 2:SUITE C2
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-6329
Mailing Address - Country:US
Mailing Address - Phone:251-990-2305
Mailing Address - Fax:
Practice Address - Street 1:22787 US HIGHWAY 98
Practice Address - Street 2:SUITE C2
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-6329
Practice Address - Country:US
Practice Address - Phone:251-990-2305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-77378OtherBLUE CROSS BLUE SHIELD
AL510-77378OtherBLUE CROSS BLUE SHIELD