Individual
MR. BRANDON W HETRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
71 N MAIN ST, WASHINGTON, PA 15301-4519
(724) 228-4218
Mailing address
1070 OLD NATIONAL PIKE, FREDERICKTOWN, PA 15333-2114
(724) 632-6801
(724) 632-6312
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007288440089
—
PA
01
—
251008110
VALUE BEHAVIORAL HEALTH
PA
Enumeration date
08/23/2010
Last updated
08/23/2010
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