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NPI Code Detail

MEDICARE: ROGER BRINKMAN LCSW

MEDICARE: ROGER BRINKMAN LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker34001462AIN

General Provider Information

NPI Number : 1316918725
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROGER BRINKMAN LCSW
Provider Business Mailing Address
First Line : 645 S ROGERS ST
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47403-2353
Country : US
Telephone Number : 812-339-1691
Fax Number : 812-337-2438
Provider Business Practice Location Address
First Line : 720 N MARR RD
Second Line :
City : COLUMBUS
State : IN
Zip : 47201-6660
Country : US
Telephone Number : 812-314-3400
Fax Number : 812-376-4875
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2006
Last Update Date : 10/07/2014

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