Provider Demographics
NPI:1720520620
Name:BRUSH, RENEE (PHD)
Entity type:Individual
Prefix:DR
First Name:RENEE
Middle Name:
Last Name:BRUSH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:SEAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:485 S INDEPENDENCE BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1129
Mailing Address - Country:US
Mailing Address - Phone:757-574-0355
Mailing Address - Fax:757-574-0356
Practice Address - Street 1:485 S INDEPENDENCE BLVD STE 104
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452
Practice Address - Country:US
Practice Address - Phone:757-574-0355
Practice Address - Fax:757-574-0356
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-08
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005575103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist