Provider Demographics
NPI:1881285062
Name:BRINKMANN, GRETCHEN (LMSW)
Entity type:Individual
Prefix:MS
First Name:GRETCHEN
Middle Name:
Last Name:BRINKMANN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:GRETCHEN
Other - Middle Name:
Other - Last Name:INFANZON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:ATTN: MS. VICTORIA CROMER
Mailing Address - Street 2:142-02 20 AVENUE
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11351
Mailing Address - Country:US
Mailing Address - Phone:718-559-0554
Mailing Address - Fax:
Practice Address - Street 1:11 ROUTE 111
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3754
Practice Address - Country:US
Practice Address - Phone:631-920-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY086359104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker