Healthcare Provider Details

I. General information

NPI: 1366750341
Provider Name (Legal Business Name): JEAN BERZON BRICKMAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2010
Last Update Date: 09/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 JUNE RD
NORTH SALEM NY
10560-1211
US

IV. Provider business mailing address

136 EAST ST
SOUTH SALEM NY
10590-2505
US

V. Phone/Fax

Practice location:
  • Phone: 914-669-5414
  • Fax:
Mailing address:
  • Phone: 914-533-2868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number014238-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: