Provider Demographics
NPI:1629324249
Name:DEAREN, BRANDON (PSYD)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:DEAREN
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 1:2093 KIRKMAN DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-4639
Mailing Address - Country:US
Mailing Address - Phone:205-848-2750
Mailing Address - Fax:
Practice Address - Street 1:121 W VICTORIA ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-2162
Practice Address - Country:US
Practice Address - Phone:310-603-1050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-01
Last Update Date:2020-03-18
Deactivation Date:2018-08-26
Deactivation Code:
Reactivation Date:2020-03-18
Provider Licenses
StateLicense IDTaxonomies
AL2020103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist