Basic Information
| Provider Information | |||||||||
| NPI: | 1457838161 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MYRHOL-CLARKE | ||||||||
| FirstName: | BRITT | ||||||||
| MiddleName: | JESSICA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 39 CHURCHHILL DOWNS DR | ||||||||
| Address2: | |||||||||
| City: | TINTON FALLS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077243804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184907059 | ||||||||
| FaxNumber: | 7186672665 | ||||||||
| Practice Location | |||||||||
| Address1: | 777 SEAVIEW AVE BLDG 10 | ||||||||
| Address2: | |||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103053409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186672429 | ||||||||
| FaxNumber: | 7186672665 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2018 | ||||||||
| LastUpdateDate: | 07/25/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | P06912 | NJ | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.