NPI 1013360361

Jesse Brand

Practitioner Emotionally Disturbed Childrens' Residential Treatment Facility Shirley, NY

Practice location

Address: 60 Forrest Ave, Shirley, NY 11967-1955
Phone: (631) 707-0190

Registered specialties

Emotionally Disturbed Childrens' Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 322D00000X

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Registry record

NPI: 1013360361
Entity type: Individual
Sex (as registered): Male
NPI issued: 21 Jul 2016
Record last updated: 21 Jul 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.