Individual
JACQUELINE BRACHT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
770 GRAND BLVD, DEER PARK, NY 11729-5750
(631) 392-4357
Mailing address
394 CENTRAL ISLIP BLVD, RONKONKOMA, NY 11779-3909
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
—
NY
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
05/13/2024
Last updated
05/13/2024
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