Doctor Name: | KRISTY LYNN BROTHERS |
NPI Number: | 1093080053 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 623146 |
Business Practice Address: | 100 Saratoga Village Blvd Suite 35 Malta, NY - 120203737 |
Business Phone Number: | 5188999235 |
Business Fax Number: | 5188999315 |
Mailing Address: | 100 Saratoga Village Blvd, Suite 35 MALTA |
State: | NY |
Postal Code: | 120203737 |
Phone Number: | 5188999235 |
Fax Number: | 5188999315 |
NPI Enumeration Date: | 03/09/2012 |
NPI Last Update Date: | 03/09/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TS0200X |
License Number: | 623146 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | School |
Taxonomy Definition: |