Healthcare Provider Details

I. General information

NPI: 1265675557
Provider Name (Legal Business Name): ADWOA TINA BREW RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2009
Last Update Date: 04/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 CHAPMAN RD SUITE 104E
NEWARK DE
19702-5490
US

IV. Provider business mailing address

260 CHAPMAN RD SUITE 104E
NEWARK DE
19702-5490
US

V. Phone/Fax

Practice location:
  • Phone: 302-737-8078
  • Fax: 302-737-8076
Mailing address:
  • Phone: 302-737-8078
  • Fax: 302-737-8076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberHHAAO-017
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberHHAAO-017
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: