Provider Demographics
NPI:1235358094
Name:PRICE, BRANDON S (MA)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:S
Last Name:PRICE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 NE 25TH AVE STE 306
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-4885
Mailing Address - Country:US
Mailing Address - Phone:352-817-0796
Mailing Address - Fax:352-671-7379
Practice Address - Street 1:1601 NE 25TH AVE STE 306
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-4885
Practice Address - Country:US
Practice Address - Phone:352-817-0796
Practice Address - Fax:352-671-7379
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health