Brodhurst, Marietta

Brodhurst, Marietta is an individual health care provider with primary practice located at 8268 164Th St , Jamaica NY 11432-1121. She recently has only one registered license in Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), which is considered as her primary health care specialty. Brodhurst, Marietta can be contacted via phone (718) 883-3225.

Contact Information

Primary practice address
8268 164Th St Jamaica NY 11432-1121
Phone: (718) 883-3225
Fax: (718) 883-6193
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 013047 New York

Profile Details

NPI number 1265511646
LBN Legal business name Brodhurst, Marietta
Credentials CASAC
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 4th, 2006
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1265511646 NPPES
New York MEDICAID 00246075

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