Jodi Brin Psychological Services LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

3346-57 Issued in WI

Legal business name

JODI BRIN PSYCHOLOGICAL SERVICES LLC

Practice address

14135 N Cedarburg Rd
Mequon, WI 53097-1416

Phone

(262) 377-2006

NPI assigned

May 31, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jodi Allison Brin, PSY.D.NPI 1629426200

Title

Clinical Psychologist

Phone

(262) 236-6693

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jodi Allison Brin, PSY.D.

  • Clinical Psychologist
  • Mequon, WI
  • NPI 1629426200
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1464652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469664000000",
    "number": "1134577133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12616 N SAINT ANNE LN",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530922263",
            "telephone_number": "262-236-6693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14135 N CEDARBURG RD",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530971416",
            "telephone_number": "262-377-2006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JODI BRIN PSYCHOLOGICAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-31",
        "last_updated": "2016-07-28",
        "status": "A",
        "authorized_official_last_name": "BRIN",
        "authorized_official_first_name": "JODI",
        "authorized_official_middle_name": "ALLISON",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "262-236-6693",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "3346-57",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ashley Mae Johnson

• Clinical Psychologist in Mequon, WI
• Providers in Mequon, WI by specialty
• Clinical Psychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.