Provider Demographics
NPI:1992940753
Name:BREWER, BARRY WALTER
Entity type:Individual
Prefix:MR
First Name:BARRY
Middle Name:WALTER
Last Name:BREWER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CEDAR ST
Mailing Address - Street 2:APT. 402
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-7037
Mailing Address - Country:US
Mailing Address - Phone:201-592-1289
Mailing Address - Fax:
Practice Address - Street 1:101 CEDAR ST
Practice Address - Street 2:APT. 402
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-7037
Practice Address - Country:US
Practice Address - Phone:201-592-1289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor