MEDICARE: COREY BRYKS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1053777680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COREY BRYKS

Provider Business Mailing Address
First Line	:	464 RACQUET LNDG
Second Line	:
City	:	APTOS
State	:	CA
Zip	:	95003-5883
Country	:	US
Telephone Number	:	831-251-5696
Fax Number	:

Provider Business Practice Location Address
First Line	:	716 OCEAN ST STE 170
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-4033
Country	:	US
Telephone Number	:	831-423-2003
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2016
Last Update Date	:	01/12/2016

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Directions to “ COREY BRYKS ” Practice Location

Language	Start Address	Practice Location

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