Provider Demographics
NPI:1710080502
Name:BRANDT, DOLORES (PHD)
Entity Type:Individual
Prefix:DR
First Name:DOLORES
Middle Name:
Last Name:BRANDT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 FLETCHER AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-4000
Mailing Address - Country:US
Mailing Address - Phone:516-872-5010
Mailing Address - Fax:
Practice Address - Street 1:15 FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-4000
Practice Address - Country:US
Practice Address - Phone:516-872-5010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011461103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV5H871Medicare ID - Type Unspecified