=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689761660
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN E. BRINTZ M.S.W
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5629 FM 1960 RD W SUITE 218
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77069-4217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-397-8181
-----------------------------------------------------
Fax | 281-586-9168
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5629 FM 1960 RD W SUITE 218
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77069-4217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-397-8181
-----------------------------------------------------
Fax | 281-586-9168
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 33363
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------