Provider Demographics
NPI:1093576167
Name:BRANTLEY, DEIJA KALYCE
Entity Type:Individual
Prefix:
First Name:DEIJA
Middle Name:KALYCE
Last Name:BRANTLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 N OAK AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CLIFTON HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:19018-1342
Mailing Address - Country:US
Mailing Address - Phone:610-883-1340
Mailing Address - Fax:
Practice Address - Street 1:26 N OAK AVE APT 1
Practice Address - Street 2:
Practice Address - City:CLIFTON HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:19018-1342
Practice Address - Country:US
Practice Address - Phone:610-883-1340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst