Provider Demographics
NPI:1992837934
Name:MACY, BRANDY DIANE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BRANDY
Middle Name:DIANE
Last Name:MACY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7676 HAZARD CENTER DR STE 500
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4508
Mailing Address - Country:US
Mailing Address - Phone:619-876-8261
Mailing Address - Fax:
Practice Address - Street 1:7676 HAZARD CENTER DR STE 500
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4508
Practice Address - Country:US
Practice Address - Phone:619-876-8261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20536103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical