Provider Information for 1316461072
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Mr. RENE GREGSTON BRATHWAITE LPCMH, ICCDP-D, NCC
Sex: Male
NPI: 1316461072
Last Updated: 2024-01-09
Certification Date: 2024-01-09
Certification Date: 2024-01-09
Details
| Name | Value | ||||||||
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| NPI | 1316461072 | ||||||||
| Enumeration Date | 2017-08-02 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 204 SHETLAND DR NEW CASTLE, DE 19720-8832 United States Phone: 917-617-7839 | Fax: | ||||||||
| Primary Practice Address | 262 CHAPMAN RD STE 203 NEWARK, DE 19702-5442 United States Phone: 302-689-3562 | Fax:302-294-1757 | ||||||||
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