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General NPI Number Information
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NPI Number | 1679974851
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Entity Type | Individual
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Provider Name | ANDREA BRENT MA
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Gender | Female
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Dates
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Enumeration Date | 09/08/2014
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Last Update Date | 04/29/2022
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Provider Practice Location Address
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Address Line | 26545 ALDEN ST
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City | MADISON HTS
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State | MI
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Zip | 48071
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Country | US
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Telephone | 248-793-1501
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Fax |
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Provider Business Mailing Address
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Address Line | 24330 JOHN R RD # 231
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City | HAZEL PARK
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State | MI
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Zip | 48030-1112
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Country | US
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Telephone | 248-793-1501
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301016808
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License Number State | MI
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