MEDICARE: MRS. MARIA BRENT LPC

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	101YM0800X	Mental Health Counselor	37PC00337700	NJ

General Provider Information

NPI Number	:	1932122553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIA BRENT LPC

Provider Business Mailing Address
First Line	:	15 PRISTINE PLACE
Second Line	:
City	:	SEWELL
State	:	NJ
Zip	:	08080
Country	:	US
Telephone Number	:	856-589-9541
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 HIGHLAND AVE
Second Line	:	SUITE C
City	:	HADDON TOWNSHIP
State	:	NJ
Zip	:	08108-2634
Country	:	US
Telephone Number	:	856-854-3155
Fax Number	:	856-854-0992

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	07/08/2007

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