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General NPI Number Information
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NPI Number | 1669626297
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Entity Type | Individual
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Provider Name | MAUREEN B BRICKLEY L.P.C. C.
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Gender | Female
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Dates
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Enumeration Date | 11/10/2008
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Last Update Date | 12/30/2019
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Provider Practice Location Address
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Address Line | 6612 GULTON CT NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-4407
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Country | US
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Telephone | 505-888-1686
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Fax | 505-888-1683
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Provider Business Mailing Address
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Address Line | 2826 STATE HIGHWAY 14 N
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City | MADRID
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State | NM
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Zip | 87010-9746
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Country | US
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Telephone | 215-803-5261
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC000657
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | CCMH0146921
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License Number State | NM
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