Provider Demographics
NPI:1952475105
Name:BRANDT, JODY ELIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:JODY
Middle Name:ELIZABETH
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 1:2288 WESTWOOD BLVD
Mailing Address - Street 2:SUITE #203
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-2000
Mailing Address - Country:US
Mailing Address - Phone:310-994-2054
Mailing Address - Fax:
Practice Address - Street 1:2288 WESTWOOD BLVD
Practice Address - Street 2:SUITE #203
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-2000
Practice Address - Country:US
Practice Address - Phone:310-994-2054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016834103TC0700X
CAPSY22694103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY20-5533276OtherEIN