Provider Demographics
NPI:1396864757
Name:BRANDON MENEFEE, ANDREA L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:L
Last Name:BRANDON MENEFEE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:L
Other - Last Name:BRANDON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:270 EAST 90TH DRIVE
Mailing Address - Street 2:OFFICE NUMBER 223
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-8102
Mailing Address - Country:US
Mailing Address - Phone:219-779-7339
Mailing Address - Fax:219-226-1324
Practice Address - Street 1:270 E 90TH DR
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-8102
Practice Address - Country:US
Practice Address - Phone:219-779-7339
Practice Address - Fax:219-979-5149
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042619A103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical