Provider Demographics
NPI:1952689283
Name:BRICKLEY, MARTHA ROMERO (MED, LPC)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:ROMERO
Last Name:BRICKLEY
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92642
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78709-2642
Mailing Address - Country:US
Mailing Address - Phone:512-577-9431
Mailing Address - Fax:
Practice Address - Street 1:4902 BROKEN BOW PASS
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-3600
Practice Address - Country:US
Practice Address - Phone:512-577-9431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13613101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional