Provider Demographics
NPI:1730198953
Name:BRICKMAN, JENNETTE BERNITA (EDD LMHC)
Entity type:Individual
Prefix:
First Name:JENNETTE
Middle Name:BERNITA
Last Name:BRICKMAN
Suffix:
Gender:F
Credentials:EDD LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3702 SPYGLASS HILL RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34288
Mailing Address - Country:US
Mailing Address - Phone:941-922-1200
Mailing Address - Fax:941-926-8897
Practice Address - Street 1:28870 US HIGHWAY 19 NORTH
Practice Address - Street 2:SUITE 360
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761
Practice Address - Country:US
Practice Address - Phone:727-773-9297
Practice Address - Fax:941-926-8897
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1294101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1294OtherLMHC