MEDICARE: DR. MEREDITH GLICK BRINEGAR PHD

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	6749	OH

General Provider Information

NPI Number	:	1891090296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MEREDITH GLICK BRINEGAR PHD

Provider Business Mailing Address
First Line	:	2221 IVY CREST DR
Second Line	:
City	:	BELLBROOK
State	:	OH
Zip	:	45305-1855
Country	:	US
Telephone Number	:	217-714-6982
Fax Number	:

Provider Business Practice Location Address
First Line	:	77 W ELMWOOD DR
Second Line	:	SUITE 202
City	:	CENTERVILLE
State	:	OH
Zip	:	45459-4239
Country	:	US
Telephone Number	:	937-436-0700
Fax Number	:

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

Provider Enumeration Date	:	01/14/2011
Last Update Date	:	01/14/2011

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