Provider Demographics
NPI:1144776477
Name:DAVIS, BRANDI (MA)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2275 BRIDGE STREET
Mailing Address - Street 2:BLDG 5 B-132
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19137
Mailing Address - Country:US
Mailing Address - Phone:215-772-0101
Mailing Address - Fax:215-772-0303
Practice Address - Street 1:2275 BRIDGE ST
Practice Address - Street 2:BLDG 5 B-132
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19137-1300
Practice Address - Country:US
Practice Address - Phone:215-772-0101
Practice Address - Fax:215-772-0303
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health