Healthcare Provider Details

I. General information

NPI: 1598049819
Provider Name (Legal Business Name): MARLY BRICE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2011
Last Update Date: 10/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

887 E NEW YORK AVE
BROOKLYN NY
11203-1309
US

IV. Provider business mailing address

1670 E 17TH ST
BROOKLYN NY
11229-1281
US

V. Phone/Fax

Practice location:
  • Phone: 718-778-0485
  • Fax: 718-778-1375
Mailing address:
  • Phone: 718-375-1200
  • Fax: 718-382-3358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: