Provider Demographics
NPI:1710276779
Name:CHILDS, BRANDIS
Entity Type:Individual
Prefix:
First Name:BRANDIS
Middle Name:
Last Name:CHILDS
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 1:422 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SWEDESBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-1008
Mailing Address - Country:US
Mailing Address - Phone:609-510-3555
Mailing Address - Fax:
Practice Address - Street 1:519 TO 525 WEST STREET
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-3529
Practice Address - Country:US
Practice Address - Phone:856-541-6092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health