Provider Demographics
NPI:1285703280
Name:BRENT, DONNA (PSYD)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:
Last Name:BRENT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2280 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:GUILDERLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12084
Mailing Address - Country:US
Mailing Address - Phone:518-456-5056
Mailing Address - Fax:578-456-5056
Practice Address - Street 1:2280 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:GUILDERLAND
Practice Address - State:NY
Practice Address - Zip Code:12084
Practice Address - Country:US
Practice Address - Phone:518-456-5056
Practice Address - Fax:518-456-6512
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011045-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist