Healthcare Provider Details

I. General information

NPI: 1982407722
Provider Name (Legal Business Name): CHAD BRINKLEY PH.D, ABPP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2025
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 N 5TH ST UNIT 401
PHILADELPHIA PA
19122-3679
US

IV. Provider business mailing address

901 N PENN ST UNIT R407
PHILADELPHIA PA
19123-3145
US

V. Phone/Fax

Practice location:
  • Phone: 267-861-3685
  • Fax:
Mailing address:
  • Phone: 713-253-0075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPS019747
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS019747
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: