Provider Demographics
NPI:1457853293
Name:BRANTLEY, EVA DOLORES
Entity Type:Individual
Prefix:MS
First Name:EVA
Middle Name:DOLORES
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 1:18 DONALD CT
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70003-3842
Mailing Address - Country:US
Mailing Address - Phone:504-342-7510
Mailing Address - Fax:
Practice Address - Street 1:1995 GENTILLY BLVD
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-1700
Practice Address - Country:US
Practice Address - Phone:504-944-0453
Practice Address - Fax:504-944-0417
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor