Provider Demographics
NPI:1851421499
Name:BRINK, LANEX (LISW)
Entity Type:Individual
Prefix:MS
First Name:LANEX
Middle Name:
Last Name:BRINK
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24300 CHAGRIN BLVD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:216-591-1673
Mailing Address - Fax:330-425-4072
Practice Address - Street 1:24300 CHAGRIN BLVD
Practice Address - Street 2:SUITE 309
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122
Practice Address - Country:US
Practice Address - Phone:216-591-1673
Practice Address - Fax:330-425-4072
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI106104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000287018OtherANTHEM