Provider Demographics
NPI:1407541089
Name:ANDERSON, WILLIAM BRANTLEY (PHD, JD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BRANTLEY
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:PHD, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 NARROWS RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10507-2526
Mailing Address - Country:US
Mailing Address - Phone:310-903-8027
Mailing Address - Fax:
Practice Address - Street 1:15 VALLEY DR STE 1
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06831-5205
Practice Address - Country:US
Practice Address - Phone:203-900-1666
Practice Address - Fax:203-635-7365
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT101YM0800X
NYP127249101YM0800X
CTSTUDENT390200000X
CT003398390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health