Provider Demographics
NPI:1669689014
Name:BRANDEIS UNIVERSITY
Entity Type:Organization
Organization Name:BRANDEIS UNIVERSITY
Other - Org Name:BRANDEIS UNIVERSITY PSYCHOLOGICAL COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:Y
Authorized Official - Last Name:BERLIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:781-736-3730
Mailing Address - Street 1:MS 061, 415 SOUTH ST
Mailing Address - Street 2:P.O. BOX 549110
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02454-9110
Mailing Address - Country:US
Mailing Address - Phone:781-736-3730
Mailing Address - Fax:781-736-3731
Practice Address - Street 1:MS 061, 415 SOUTH ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02454-9110
Practice Address - Country:US
Practice Address - Phone:781-736-3730
Practice Address - Fax:781-736-3731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
Not Answered103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty