Provider Demographics
NPI:1083040646
Name:BRANDOW, THERESA F (MS)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:F
Last Name:BRANDOW
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 HORIZON VIEW DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-3037
Mailing Address - Country:US
Mailing Address - Phone:631-375-4359
Mailing Address - Fax:
Practice Address - Street 1:76 HORIZON VIEW DR
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-3037
Practice Address - Country:US
Practice Address - Phone:631-375-4359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool