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General NPI Number Information
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NPI Number | 1255794137
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Entity Type | Individual
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Provider Name | MR. GLENN BRANTLEY
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Gender | Male
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Dates
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Enumeration Date | 03/30/2016
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Last Update Date | 03/30/2016
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Provider Practice Location Address
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Address Line | 777 SEAVIEW AVE SBPC:HEALTH HOME PROGRAM
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City | STATEN ISLAND
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State | NY
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Zip | 10305
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Country | US
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Telephone | 718-668-8061
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Fax | 718-668-8070
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Provider Business Mailing Address
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Address Line | 777 SEAVIEW AVE. SOUTH BEACH PSYCHIATRIC CENTER
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City | STATEN ISLAND
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State | NY
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Zip | 10305
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Country | US
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Telephone | 718-668-8061
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Fax | 718-668-8070
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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