Provider Demographics
NPI:1699109694
Name:BRAITHWAITE, EMILY DAIKTEA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:DAIKTEA
Last Name:BRAITHWAITE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 ISLAND LN
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-6994
Mailing Address - Country:US
Mailing Address - Phone:609-287-0968
Mailing Address - Fax:
Practice Address - Street 1:2235 OCEAN HEIGHTS AVE
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-5933
Practice Address - Country:US
Practice Address - Phone:609-287-0968
Practice Address - Fax:609-927-2796
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
NJ44SC057809001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No172V00000XOther Service ProvidersCommunity Health Worker