Healthcare Provider Details

I. General information

NPI: 1669626297
Provider Name (Legal Business Name): MAUREEN B BRICKLEY L.P.C. C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2008
Last Update Date: 12/30/2019
Certification Date: 12/30/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6612 GULTON CT NE
ALBUQUERQUE NM
87109-4407
US

IV. Provider business mailing address

2826 STATE HIGHWAY 14 N
MADRID NM
87010-9746
US

V. Phone/Fax

Practice location:
  • Phone: 505-888-1686
  • Fax: 505-888-1683
Mailing address:
  • Phone: 215-803-5261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC000657
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCCMH0146921
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: