Provider Demographics
NPI:1992859003
Name:BRICKLIN, SETH MICHAEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:MICHAEL
Last Name:BRICKLIN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22020 CLARENDON ST
Mailing Address - Street 2:#208
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-6335
Mailing Address - Country:US
Mailing Address - Phone:818-332-2287
Mailing Address - Fax:818-206-1080
Practice Address - Street 1:22020 CLARENDON ST
Practice Address - Street 2:#208
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-6335
Practice Address - Country:US
Practice Address - Phone:818-332-2287
Practice Address - Fax:818-206-1080
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18831103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASET3615OtherLA COUNTY DMH PROVIDER #