Provider Demographics
NPI:1457636391
Name:BRANDT, MAYA RITA (MS)
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:RITA
Last Name:BRANDT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 E ATLANTIC BLVD
Mailing Address - Street 2:# 108A
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-7372
Mailing Address - Country:US
Mailing Address - Phone:954-941-2323
Mailing Address - Fax:
Practice Address - Street 1:911 E ATLANTIC BLVD
Practice Address - Street 2:# 108A
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-7372
Practice Address - Country:US
Practice Address - Phone:954-941-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program