Provider Demographics
NPI:1679858542
Name:TAYLOR, BRANDI
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 MAIN ST.
Mailing Address - Street 2:SUITE 301
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475
Mailing Address - Country:US
Mailing Address - Phone:860-395-6380
Mailing Address - Fax:860-395-6382
Practice Address - Street 1:263 MAIN ST.
Practice Address - Street 2:SUITE 301
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475
Practice Address - Country:US
Practice Address - Phone:860-395-6380
Practice Address - Fax:860-395-6382
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor