Healthcare Provider Details

I. General information

NPI: 1356150528
Provider Name (Legal Business Name): GAIL HENRIETTA BRIGHTWELL PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 W ELIZABETH AVE APT 147
LINDEN NJ
07036-4476
US

IV. Provider business mailing address

307 W ELIZABETH AVE APT 147
LINDEN NJ
07036-4476
US

V. Phone/Fax

Practice location:
  • Phone: 646-228-7685
  • Fax:
Mailing address:
  • Phone: 646-228-7685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number024472
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: