| Doctor Name: | SALLY ROSE BRINZA |
| NPI Number: | 1023119914 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHD LP |
| License Number: | LP2586 |
| Business Practice Address: | 7225 Forestview Ln N Maple Grove, MN - 55369 |
| Business Phone Number: | 6129785058 |
| Business Fax Number: | 7632011095 |
| Mailing Address: | 14600 43rd Av N, PLYMOUTH |
| State: | MN |
| Postal Code: | 55446 |
| Phone Number: | 6129785058 |
| Fax Number: | 7632011095 |
| NPI Enumeration Date: | 09/26/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | LP2586 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |