Provider Demographics
NPI:1467768366
Name:BRATHWAITE-CLARKE, VIRGINIA
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:BRATHWAITE-CLARKE
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 1:1723 WOODBOURNE RD
Mailing Address - Street 2:SUITE A-110
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19057-1510
Mailing Address - Country:US
Mailing Address - Phone:267-587-2300
Mailing Address - Fax:267-587-2305
Practice Address - Street 1:1723 WOODBOURNE RD
Practice Address - Street 2:SUITE A-110
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19057-1510
Practice Address - Country:US
Practice Address - Phone:267-587-2300
Practice Address - Fax:267-587-2305
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health