Provider Demographics
NPI:1508376047
Name:NEW, BRANDALYN M (BCBA)
Entity Type:Individual
Prefix:
First Name:BRANDALYN
Middle Name:M
Last Name:NEW
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:BRANDALYN
Other - Middle Name:
Other - Last Name:SIMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCBA
Mailing Address - Street 1:1311 HARMONY CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:COLQUITT
Mailing Address - State:GA
Mailing Address - Zip Code:39837
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:220 RIVER ST
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39817-3654
Practice Address - Country:US
Practice Address - Phone:256-926-8246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-11
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst