Provider Demographics
NPI:1700072501
Name:BRANDON, RHEA (LEP)
Entity Type:Individual
Prefix:
First Name:RHEA
Middle Name:
Last Name:BRANDON
Suffix:
Gender:F
Credentials:LEP
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 1613
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-6613
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4185 BLACKHAWK PLAZA CIR
Practice Address - Street 2:SUITE 210
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94506-4694
Practice Address - Country:US
Practice Address - Phone:925-648-4800
Practice Address - Fax:925-648-2530
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALEP 2801103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALEP 2801OtherSTATE LICENSE