Individual
TYQUAN BRACKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
460 BRIELLE AVE, STATEN ISLAND, NY 10314-6427
(718) 816-6589
Mailing address
460 BRIELLE AVE, STATEN ISLAND, NY 10314-6427
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
03/26/2015
Last updated
03/26/2015
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