Provider Demographics
NPI:1912259136
Name:GOING, BRANDEE ILENE (LAC,LMT)
Entity Type:Individual
Prefix:MRS
First Name:BRANDEE
Middle Name:ILENE
Last Name:GOING
Suffix:
Gender:F
Credentials:LAC,LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 SAYBROOK RD
Mailing Address - Street 2:
Mailing Address - City:HADDAM
Mailing Address - State:CT
Mailing Address - Zip Code:06438-1324
Mailing Address - Country:US
Mailing Address - Phone:860-304-9809
Mailing Address - Fax:
Practice Address - Street 1:93 MARKET SQ
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-2900
Practice Address - Country:US
Practice Address - Phone:860-578-9865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT554171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist