Healthcare Provider Details

I. General information

NPI: 1427265305
Provider Name (Legal Business Name): DIANNE ESTELLE BRINKER MSW, LCSW, PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1138 KING ST SUITE 206
CHRISTIANSTED VI
00820-4943
US

IV. Provider business mailing address

1138 KING ST SUITE 206
CHRISTIANSTED VI
00820-4943
US

V. Phone/Fax

Practice location:
  • Phone: 340-773-3443
  • Fax:
Mailing address:
  • Phone: 340-773-3443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2-2027437-2007
License Number StateVI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: