Provider Demographics
NPI:1457679276
Name:DENNIS, BRANDON CHARLES (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:CHARLES
Last Name:DENNIS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4950 NORTON HEALTHCARE BLVD STE 305
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-2849
Mailing Address - Country:US
Mailing Address - Phone:502-394-6460
Mailing Address - Fax:502-394-6465
Practice Address - Street 1:4950 NORTON HEALTHCARE BLVD STE 305
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241
Practice Address - Country:US
Practice Address - Phone:502-394-6460
Practice Address - Fax:502-394-6465
Is Sole Proprietor?:No
Enumeration Date:2010-05-05
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1654103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201398770A (KOHMG)Medicaid
KYP017311-KOHMGOtherRR MEDICARE
KY7100435060 (KOHMG)Medicaid
KYK214080-KOHMGOtherMEDICARE