Healthcare Provider Details

I. General information

NPI: 1699109694
Provider Name (Legal Business Name): EMILY DAIKTEA BRAITHWAITE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 02/04/2020
Certification Date: 02/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2235 OCEAN HEIGHTS AVE
EGG HARBOR TOWNSHIP NJ
08234-5933
US

IV. Provider business mailing address

504 ISLAND LN
EGG HARBOR TOWNSHIP NJ
08234-6994
US

V. Phone/Fax

Practice location:
  • Phone: 609-287-0968
  • Fax: 609-927-2796
Mailing address:
  • Phone: 609-287-0968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05780900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: