Individual
JEFFREY BRENTLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
205 S WHITING ST STE 312, ALEXANDRIA, VA 22304-3632
(703) 249-5160
Mailing address
PO BOX 1933, ALEXANDRIA, VA 22313-1933
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
078543
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00244606
—
NY
Enumeration date
05/17/2007
Last updated
05/13/2022
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