Provider Demographics
NPI:1770565442
Name:BRICKA, FREDRIC HARVEY (LCSW)
Entity type:Individual
Prefix:MR
First Name:FREDRIC
Middle Name:HARVEY
Last Name:BRICKA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3640 S PLAZA TRL STE 103D
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-3363
Mailing Address - Country:US
Mailing Address - Phone:757-818-4541
Mailing Address - Fax:757-299-3031
Practice Address - Street 1:3640 S PLAZA TRL STE 103D
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-3363
Practice Address - Country:US
Practice Address - Phone:757-818-4541
Practice Address - Fax:757-299-3031
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040045351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA083807MOtherSENTARA
VA179019OtherBLUE CROSS/BLUE SHIELD
VA010142768Medicaid