MEDICARE: KAROL SOLOMON BRIGHAM PH.D.

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	103T00000X	Psychologist	PY3059	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	73761	OTHER	FL	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1336134949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAROL SOLOMON BRIGHAM PH.D.

Provider Business Mailing Address
First Line	:	1615 VILLAGE SQUARE BLVD STE 4
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32309-2770
Country	:	US
Telephone Number	:	850-224-4442
Fax Number	:	850-574-6030

Provider Business Practice Location Address
First Line	:	1003 N ADAMS ST
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32303-6132
Country	:	US
Telephone Number	:	850-224-4442
Fax Number	:	850-574-6030

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	04/04/2019

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