Provider Demographics
NPI:1174817498
Name:BRAND, JESSE GABRIEL
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:GABRIEL
Last Name:BRAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8555 16TH ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-2816
Mailing Address - Country:US
Mailing Address - Phone:301-562-7200
Mailing Address - Fax:301-563-7199
Practice Address - Street 1:1201 SEVEN LOCKS RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20854-2931
Practice Address - Country:US
Practice Address - Phone:301-562-7200
Practice Address - Fax:301-424-1565
Is Sole Proprietor?:No
Enumeration Date:2011-06-03
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MD05119103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist