Provider Demographics
NPI:1164733259
Name:BRANDES, CHARLES E (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:E
Last Name:BRANDES
Suffix:
Gender:M
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:PO BOX 606
Mailing Address - Street 2:
Mailing Address - City:KENTFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94914-0606
Mailing Address - Country:US
Mailing Address - Phone:415-922-5632
Mailing Address - Fax:415-464-9338
Practice Address - Street 1:2252 FILLMORE ST
Practice Address - Street 2:STE 402
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-7805
Practice Address - Country:US
Practice Address - Phone:415-922-5632
Practice Address - Fax:415-464-9338
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10559103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical