Provider Demographics
NPI:1932568920
Name:BREWINGTON, RAVEN ASHLEY
Entity Type:Individual
Prefix:
First Name:RAVEN
Middle Name:ASHLEY
Last Name:BREWINGTON
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 1:155 EMILY AVE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-4223
Mailing Address - Country:US
Mailing Address - Phone:516-263-0138
Mailing Address - Fax:
Practice Address - Street 1:155 EMILY AVE
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-4223
Practice Address - Country:US
Practice Address - Phone:516-263-0138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer