Provider Demographics
NPI:1538188065
Name:BRETT, STANLEY R (PHD)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:R
Last Name:BRETT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:STANLEY
Other - Middle Name:R
Other - Last Name:BRETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:42 CONCOURSE E
Mailing Address - Street 2:
Mailing Address - City:BRIGHTWATERS
Mailing Address - State:NY
Mailing Address - Zip Code:11718-1510
Mailing Address - Country:US
Mailing Address - Phone:631-665-3432
Mailing Address - Fax:631-665-3432
Practice Address - Street 1:42 CONCOURSE E
Practice Address - Street 2:
Practice Address - City:BRIGHTWATERS
Practice Address - State:NY
Practice Address - Zip Code:11718-1510
Practice Address - Country:US
Practice Address - Phone:831-665-3432
Practice Address - Fax:631-665-3432
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003118-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00666922Medicaid
NYA300000646Medicare PIN