Doctor Name: | BRENDA DAUGHERTY-SHRIVASTAVA |
NPI Number: | 1104156157 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | PC000561 |
Business Practice Address: | 214 S 7th Ave Clarion, PA - 162142099 |
Business Phone Number: | 8142266252 |
Business Fax Number: | |
Mailing Address: | 214 S 7th Ave, CLARION |
State: | PA |
Postal Code: | 162142099 |
Phone Number: | 8142266252 |
Fax Number: | |
NPI Enumeration Date: | 01/13/2010 |
NPI Last Update Date: | 01/13/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | PC000561 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |