Provider Demographics
NPI:1821295569
Name:BRENT, DEANDRA
Entity Type:Individual
Prefix:MS
First Name:DEANDRA
Middle Name:
Last Name:BRENT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEANDREA
Other - Middle Name:
Other - Last Name:HERRING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:463 7TH AVE # 18TH
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-7604
Mailing Address - Country:US
Mailing Address - Phone:212-582-9100
Mailing Address - Fax:
Practice Address - Street 1:463 7TH AVE # 18TH
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-7604
Practice Address - Country:US
Practice Address - Phone:212-582-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker