Individual
MR. GLENN BRANTLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
777 SEAVIEW AVE, SBPC:HEALTH HOME PROGRAM, STATEN ISLAND, NY 10305
(718) 668-8061
(718) 668-8070
Mailing address
777 SEAVIEW AVE., SOUTH BEACH PSYCHIATRIC CENTER, STATEN ISLAND, NY 10305
(718) 668-8061
(718) 668-8070
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00769306
—
NY
Enumeration date
03/30/2016
Last updated
03/30/2016
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