Healthcare Provider Details

I. General information

NPI: 1710705017
Provider Name (Legal Business Name): BRYNN MARIE HAGGERTY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2024
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4023 KENNETT PIKE
WILMINGTON DE
19807-2018
US

IV. Provider business mailing address

47 MESSINA HILL RD
DOVER DE
19904-1831
US

V. Phone/Fax

Practice location:
  • Phone: 484-577-9928
  • Fax:
Mailing address:
  • Phone: 302-382-9953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: