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NPI Code Detail

MEDICARE: MR. BRETT GLENN ALTHAFER LCSW

MEDICARE: MR. BRETT GLENN ALTHAFER LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorSW9244FL
21041C0700XClinical Social WorkerSW 9244FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1467761593
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRETT GLENN ALTHAFER LCSW
Provider Business Mailing Address
First Line : 1120 TURNBULL ST
Second Line :
City : NEW SMYRNA BEACH
State : FL
Zip : 32168-6040
Country : US
Telephone Number : 386-402-5169
Fax Number :
Provider Business Practice Location Address
First Line : 201 W PLYMOUTH AVE
Second Line :
City : DELAND
State : FL
Zip : 32720-2753
Country : US
Telephone Number : 386-873-2963
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/07/2010
Last Update Date : 03/04/2022

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