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General NPI Number Information
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NPI Number | 1386778561
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Entity Type | Individual
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Provider Name | BRENT ST. CLAIR
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Gender | Male
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 12/10/2019
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Provider Practice Location Address
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Address Line | 33 DENISON PKWY W
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City | CORNING
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State | NY
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Zip | 14830-2613
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Country | US
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Telephone | 607-937-3274
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Fax |
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Provider Business Mailing Address
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Address Line | 115 LIBERTY ST
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City | BATH
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State | NY
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Zip | 14810-1508
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Country | US
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Telephone |
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Fax |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 47612
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 001090
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License Number State | NY
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