Provider Demographics
NPI:1144588419
Name:BRANDO, CRAIG
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:BRANDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CRAIG
Other - Middle Name:DOMINIC
Other - Last Name:BEDARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:31 N UNION ST
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-2915
Mailing Address - Country:US
Mailing Address - Phone:401-725-2520
Mailing Address - Fax:401-723-9595
Practice Address - Street 1:31 N UNION ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-2915
Practice Address - Country:US
Practice Address - Phone:401-725-2520
Practice Address - Fax:401-723-9595
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)