Provider Demographics
NPI:1922153774
Name:BRANDT, ROBERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:BRANDT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KING ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3243
Mailing Address - Country:US
Mailing Address - Phone:413-586-6542
Mailing Address - Fax:413-586-7533
Practice Address - Street 1:100 KING ST
Practice Address - Street 2:SUITE 202
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3243
Practice Address - Country:US
Practice Address - Phone:413-586-6542
Practice Address - Fax:413-586-7533
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2318103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAWO2450Medicare ID - Type Unspecified