Healthcare Provider Details

I. General information

NPI: 1568468841
Provider Name (Legal Business Name): PHILIP L BRILEY PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 03/03/2010
Certification Date:
Deactivation Date: 03/15/2006
Reactivation Date: 03/23/2006

III. Provider practice location address

7700 OLD BRANCH AVE STE B105
CLINTON MD
20735-1628
US

IV. Provider business mailing address

7700 OLD BRANCH AVE STE B105
CLINTON MD
20735-1628
US

V. Phone/Fax

Practice location:
  • Phone: 301-934-8811
  • Fax: 301-934-9321
Mailing address:
  • Phone: 301-934-8811
  • Fax: 301-934-9321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number00628
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: