Provider Demographics
NPI:1487688644
Name:BRANDES, JOHN R (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:BRANDES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 JEFFERSON ST STE 210A
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-2470
Mailing Address - Country:US
Mailing Address - Phone:707-255-7786
Mailing Address - Fax:707-252-1092
Practice Address - Street 1:1303 JEFFERSON ST STE 210A
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-2470
Practice Address - Country:US
Practice Address - Phone:707-255-7786
Practice Address - Fax:707-252-1092
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY4978103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical