MEDICARE: JEFFREY BRENTLEY

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
1	1041C0700X	Clinical Social Worker	078543	NY

Other Identifiers

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

General Provider Information

NPI Number	:	1598972333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY BRENTLEY

Provider Business Mailing Address
First Line	:	PO BOX 1933
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22313-1933
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 S WHITING ST STE 312
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22304-3632
Country	:	US
Telephone Number	:	703-249-5160
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	05/13/2022

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Directions to “ JEFFREY BRENTLEY ” Practice Location

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