Provider Demographics
NPI:1811193782
Name:BRINKLEY, RICHARD FAIRLIE (LCSW, CAP, NCGC II)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:FAIRLIE
Last Name:BRINKLEY
Suffix:
Gender:M
Credentials:LCSW, CAP, NCGC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13761 FOREST LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-5018
Mailing Address - Country:US
Mailing Address - Phone:727-512-3264
Mailing Address - Fax:727-536-8040
Practice Address - Street 1:1101 BELCHER RD S STE E
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-3356
Practice Address - Country:US
Practice Address - Phone:727-512-3264
Practice Address - Fax:727-536-8040
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW65271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical