Doctor Name: | DR. ASTRA BRANTLEY |
NPI Number: | 1114955648 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PSYD |
License Number: | 02035 |
Business Practice Address: | 14821 Hanover Pike Upperco, MD - 211559736 |
Business Phone Number: | 4104295777 |
Business Fax Number: | 4104295778 |
Mailing Address: | 14821 Hanover Pike, UPPERCO |
State: | MD |
Postal Code: | 211559736 |
Phone Number: | 4104295777 |
Fax Number: | 4104295778 |
NPI Enumeration Date: | 06/30/2006 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TF0000X |
License Number: | 02035 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Family |
Taxonomy Definition: |