Provider Demographics
NPI:1265675557
Name:BREW, ADWOA TINA (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:ADWOA
Middle Name:TINA
Last Name:BREW
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 CHAPMAN RD
Mailing Address - Street 2:SUITE 104E
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-5490
Mailing Address - Country:US
Mailing Address - Phone:302-737-8078
Mailing Address - Fax:302-737-8076
Practice Address - Street 1:260 CHAPMAN RD
Practice Address - Street 2:SUITE 104E
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-5490
Practice Address - Country:US
Practice Address - Phone:302-737-8078
Practice Address - Fax:302-737-8076
Is Sole Proprietor?:No
Enumeration Date:2009-04-16
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEHHAAO-017103TA0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent