Provider Demographics
NPI:1114657129
Name:VICARIO, BRETT ANTHONY (PH D)
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:ANTHONY
Last Name:VICARIO
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2597 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-6401
Mailing Address - Country:US
Mailing Address - Phone:541-829-3105
Mailing Address - Fax:
Practice Address - Street 1:374 W 12TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-1633
Practice Address - Country:US
Practice Address - Phone:541-829-3105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-13
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1694103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling