Provider Demographics
NPI:1063683035
Name:HORSHAM-BRATHWAITE, CICELY N (PHD)
Entity Type:Individual
Prefix:DR
First Name:CICELY
Middle Name:N
Last Name:HORSHAM-BRATHWAITE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 W 30TH ST
Mailing Address - Street 2:FL 11
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-4406
Mailing Address - Country:US
Mailing Address - Phone:516-647-1712
Mailing Address - Fax:
Practice Address - Street 1:7 W 30TH ST
Practice Address - Street 2:FL 11
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-4406
Practice Address - Country:US
Practice Address - Phone:516-647-1712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016586103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling