Provider Demographics
NPI:1891090296
Name:BRINEGAR, MEREDITH GLICK (PHD)
Entity Type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:GLICK
Last Name:BRINEGAR
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 1:2221 IVY CREST DR
Mailing Address - Street 2:
Mailing Address - City:BELLBROOK
Mailing Address - State:OH
Mailing Address - Zip Code:45305-1855
Mailing Address - Country:US
Mailing Address - Phone:217-714-6982
Mailing Address - Fax:
Practice Address - Street 1:77 W ELMWOOD DR
Practice Address - Street 2:SUITE 202
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4239
Practice Address - Country:US
Practice Address - Phone:937-436-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-14
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6749103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist