Healthcare Provider Details

I. General information

NPI: 1003089012
Provider Name (Legal Business Name): MARY Y BRINKMEYER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 JOHN PAUL JONES CIR NAVAL MEDICAL CENTER
PORTSMOUTH VA
23708-2111
US

IV. Provider business mailing address

203 NW 13TH AVE
GAINESVILLE FL
32601-4220
US

V. Phone/Fax

Practice location:
  • Phone: 757-953-5000
  • Fax:
Mailing address:
  • Phone: 352-256-4047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPY 7698
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: