Provider Demographics
NPI:1558038695
Name:GARY, BRANDAIS QUAY
Entity Type:Individual
Prefix:
First Name:BRANDAIS
Middle Name:QUAY
Last Name:GARY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRANDAIS
Other - Middle Name:SANTIAGO
Other - Last Name:GARY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1681 CROWN AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-6303
Mailing Address - Country:US
Mailing Address - Phone:717-208-6686
Mailing Address - Fax:727-208-6687
Practice Address - Street 1:1681 CROWN AVE STE 10
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6303
Practice Address - Country:US
Practice Address - Phone:717-208-6686
Practice Address - Fax:727-208-6687
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
PA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor