Provider Demographics
NPI:1881571552
Name:BREWER, MITCHAEL
Entity type:Individual
Prefix:
First Name:MITCHAEL
Middle Name:
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 1:17 NEWKIRK AVE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08629-1429
Mailing Address - Country:US
Mailing Address - Phone:215-478-3611
Mailing Address - Fax:
Practice Address - Street 1:17 NEWKIRK AVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08629-1429
Practice Address - Country:US
Practice Address - Phone:215-478-3611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-16
Last Update Date:2025-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst