Provider Demographics
NPI:1134664162
Name:STOOPS, BRANDI (PHD)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:STOOPS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 GREEN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-1812
Mailing Address - Country:US
Mailing Address - Phone:805-453-7907
Mailing Address - Fax:
Practice Address - Street 1:795 GREEN VALLEY DR
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-1812
Practice Address - Country:US
Practice Address - Phone:805-453-7907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28395103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist