Provider Demographics
NPI:1700116829
Name:RIALS, BRANDI M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BRANDI
Middle Name:M
Last Name:RIALS
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 1:221 GREENWICH CIR
Mailing Address - Street 2:111
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-2890
Mailing Address - Country:US
Mailing Address - Phone:561-429-2397
Mailing Address - Fax:
Practice Address - Street 1:221 GREENWICH CIR
Practice Address - Street 2:111
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-2890
Practice Address - Country:US
Practice Address - Phone:561-429-2397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-12
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.007822103TC0700X
FLPY8421103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical