Provider Demographics
NPI:1447501200
Name:BRIN, ANDREW KENNETH (RRW)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:KENNETH
Last Name:BRIN
Suffix:
Gender:M
Credentials:RRW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6444 SAN VICENTE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5338
Mailing Address - Country:US
Mailing Address - Phone:310-213-5843
Mailing Address - Fax:
Practice Address - Street 1:6444 SAN VICENTE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5338
Practice Address - Country:US
Practice Address - Phone:310-213-5843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)