Provider Demographics
NPI:1740380260
Name:BRANDON, CHRISTINE MARIAH
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:MARIAH
Last Name:BRANDON
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:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:CUMMINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01026
Mailing Address - Country:US
Mailing Address - Phone:413-442-7474
Mailing Address - Fax:413-442-6660
Practice Address - Street 1:232 1ST ST.
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201
Practice Address - Country:US
Practice Address - Phone:413-446-7447
Practice Address - Fax:413-442-6660
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA102445101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP02301Medicare ID - Type Unspecified
MAR41817Medicare UPIN