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NPI Code Detail

MEDICARE: MRS. EMILY DAIKTEA BRAITHWAITE LCSW

MEDICARE: MRS. EMILY DAIKTEA BRAITHWAITE 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
1172V00000XCommunity Health Worker
21041C0700XClinical Social Worker44SC05780900NJ

General Provider Information

NPI Number : 1699109694
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. EMILY DAIKTEA BRAITHWAITE LCSW
Provider Business Mailing Address
First Line : 504 ISLAND LN
Second Line :
City : EGG HARBOR TOWNSHIP
State : NJ
Zip : 08234-6994
Country : US
Telephone Number : 609-287-0968
Fax Number :
Provider Business Practice Location Address
First Line : 2235 OCEAN HEIGHTS AVE
Second Line :
City : EGG HARBOR TOWNSHIP
State : NJ
Zip : 08234-5933
Country : US
Telephone Number : 609-287-0968
Fax Number : 609-927-2796
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2013
Last Update Date : 02/04/2020

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