Provider Demographics
NPI:1235534330
Name:BRANDES, AMBER RACHAEL (PSYD)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:RACHAEL
Last Name:BRANDES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 E 89TH ST
Mailing Address - Street 2:APT. 4G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-5067
Mailing Address - Country:US
Mailing Address - Phone:248-330-3869
Mailing Address - Fax:
Practice Address - Street 1:389 E 89TH ST
Practice Address - Street 2:APT. 4G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-5067
Practice Address - Country:US
Practice Address - Phone:248-330-3869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-31
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020716-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical