Provider Demographics
NPI:1306421300
Name:BRENEMAN, D'AJANIQUE TASHELE (RBT)
Entity type:Individual
Prefix:
First Name:D'AJANIQUE
Middle Name:TASHELE
Last Name:BRENEMAN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:D'AJANIQUE
Other - Middle Name:TASHELE
Other - Last Name:HOLLOWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 RATHTON RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3717
Mailing Address - Country:US
Mailing Address - Phone:717-885-5906
Mailing Address - Fax:717-600-8179
Practice Address - Street 1:1 RATHTON RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3717
Practice Address - Country:US
Practice Address - Phone:717-885-5906
Practice Address - Fax:717-600-8179
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARBT-21-158262106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician