Provider Demographics
NPI:1285070714
Name:BRANDISH, JA'ME ANN (MA)
Entity type:Individual
Prefix:
First Name:JA'ME
Middle Name:ANN
Last Name:BRANDISH
Suffix:
Gender:F
Credentials:MA
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 217
Mailing Address - Street 2:
Mailing Address - City:ROCK CAVE
Mailing Address - State:WV
Mailing Address - Zip Code:26234-0217
Mailing Address - Country:US
Mailing Address - Phone:304-924-6262
Mailing Address - Fax:304-924-5460
Practice Address - Street 1:78 QUEENS ALLEY RD
Practice Address - Street 2:
Practice Address - City:ROCK CAVE
Practice Address - State:WV
Practice Address - Zip Code:26234-5890
Practice Address - Country:US
Practice Address - Phone:304-924-6262
Practice Address - Fax:304-924-5460
Is Sole Proprietor?:No
Enumeration Date:2013-05-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1067103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVQ43388COtherMEDICARE PTAN