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General NPI Number Information
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NPI Number | 1790267680
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Entity Type | Individual
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Provider Name | SYRITA MARIE BRASWELL-O'NEAL BS
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Gender | Female
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Dates
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Enumeration Date | 09/06/2018
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Last Update Date | 08/05/2024
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Provider Practice Location Address
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Address Line | 301 CHESTERFIELD RD
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City | EAST LYME
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State | CT
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Zip | 06333-1003
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Country | US
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Telephone | 860-263-9052
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Fax |
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Provider Business Mailing Address
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Address Line | 21 GERRISH AVE
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City | EAST HAVEN
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State | CT
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Zip | 06512-3231
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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