MEDICARE: DR. RODNEY MARTIN BRIM 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	103TC0700X	Clinical Psychologist	31897	CA
2	103T00000X	Psychologist	31897	CA

General Provider Information

NPI Number	:	1851901045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RODNEY MARTIN BRIM PH.D.

Provider Business Mailing Address
First Line	:	301 NAUTICAL HTS
Second Line	:
City	:	SMITH RIVER
State	:	CA
Zip	:	95567-9568
Country	:	US
Telephone Number	:	541-813-9173
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 NAUTICAL HTS
Second Line	:
City	:	SMITH RIVER
State	:	CA
Zip	:	95567-9568
Country	:	US
Telephone Number	:	541-813-9173
Fax Number	:

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

Provider Enumeration Date	:	08/03/2020
Last Update Date	:	08/03/2020

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