Provider Demographics
NPI:1285282400
Name:BRICKMAN, HALEY
Entity type:Individual
Prefix:DR
First Name:HALEY
Middle Name:
Last Name:BRICKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2266 1/2 E MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209-3910
Mailing Address - Country:US
Mailing Address - Phone:614-515-2663
Mailing Address - Fax:
Practice Address - Street 1:2266 1/2 E MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43209-3910
Practice Address - Country:US
Practice Address - Phone:614-515-2663
Practice Address - Fax:614-515-2663
Is Sole Proprietor?:No
Enumeration Date:2019-08-30
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHP.08291103T00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1473276Medicaid