Provider Demographics
NPI:1952507832
Name:BRABSON, GORDANA
Entity Type:Individual
Prefix:
First Name:GORDANA
Middle Name:
Last Name:BRABSON
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 1:2656 STEPHEN PL
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-7468
Mailing Address - Country:US
Mailing Address - Phone:805-252-5899
Mailing Address - Fax:
Practice Address - Street 1:3920 W CHARLESTON BLVD STE O
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1633
Practice Address - Country:US
Practice Address - Phone:702-478-5541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1295817302Medicare UPIN