Provider Demographics
NPI:1336262781
Name:OCCHIPINTI, BRENDA S (PHD)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:S
Last Name:OCCHIPINTI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 N BEERS ST STE 2B
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1525
Mailing Address - Country:US
Mailing Address - Phone:732-264-2440
Mailing Address - Fax:732-672-7724
Practice Address - Street 1:717 N BEERS ST STE 2B
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1525
Practice Address - Country:US
Practice Address - Phone:732-264-2440
Practice Address - Fax:732-672-7724
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00262600103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ11575840OtherCAQH ID#
NJ056515Medicare UPIN
NJ11575840OtherCAQH ID#
NJ0005775306Medicare UPIN