Healthcare Provider Details

I. General information

NPI: 1346312675
Provider Name (Legal Business Name): KATHLEEN ANN BREHONY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 OLD TOM STREET SUITE 207
MANTEO NC
27954
US

IV. Provider business mailing address

PO BOX 121
MANTEO NC
27954-0121
US

V. Phone/Fax

Practice location:
  • Phone: 252-473-4004
  • Fax: 252-475-1017
Mailing address:
  • Phone: 252-473-4004
  • Fax: 252-475-1017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1430
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: