Healthcare Provider Details

I. General information

NPI: 1235435066
Provider Name (Legal Business Name): DAVIS K BRIMBERG PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2011
Last Update Date: 01/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 CERRILLOS RD STE 719D SUITE #719D
SANTA FE NM
87507-2699
US

IV. Provider business mailing address

3600 CERRILLOS RD STE 719D SUITE #719D
SANTA FE NM
87507-2699
US

V. Phone/Fax

Practice location:
  • Phone: 505-984-3156
  • Fax:
Mailing address:
  • Phone: 505-984-3156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY 1158
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: