Provider Demographics
NPI:1366537516
Name:BREWSTER, RICHARD J (PSYD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:BREWSTER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 TOBY DR
Mailing Address - Street 2:
Mailing Address - City:SUCCASUNNA
Mailing Address - State:NJ
Mailing Address - Zip Code:07876-1844
Mailing Address - Country:US
Mailing Address - Phone:973-584-5513
Mailing Address - Fax:
Practice Address - Street 1:295 BLOOMFIELD AVE
Practice Address - Street 2:2 ND. FLOOR
Practice Address - City:CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-5145
Practice Address - Country:US
Practice Address - Phone:973-228-0033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00133100103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ452907Medicare ID - Type UnspecifiedMEDICARE NUMBER