Provider Demographics
NPI:1760297436
Name:BRICK, SUSAN MARIE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:BRICK
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 CHILDRESS ST
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3868
Mailing Address - Country:US
Mailing Address - Phone:757-567-3995
Mailing Address - Fax:
Practice Address - Street 1:97 CHILDRESS ST
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3868
Practice Address - Country:US
Practice Address - Phone:757-567-3995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024192492363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health