Healthcare Provider Details

I. General information

NPI: 1134281678
Provider Name (Legal Business Name): JEANNETTE M BRISCOE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 OFFICE PARK CIR SUITE 115
MOUNTAIN BRK AL
35223-2510
US

IV. Provider business mailing address

3 OFFICE PARK CIR SUITE 115
MOUNTAIN BRK AL
35223-2510
US

V. Phone/Fax

Practice location:
  • Phone: 205-912-2000
  • Fax: 205-945-1890
Mailing address:
  • Phone: 205-912-2000
  • Fax: 205-945-1890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0574C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: