Provider Demographics
NPI:1952766073
Name:GAVETT, BRANDON (PHD, ABPP)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:GAVETT
Suffix:
Gender:M
Credentials:PHD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UC DAVIS NEUROSCIENCES CLINIC
Mailing Address - Street 2:3160 FOLSOM BLVD, SUITE 2100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UC DAVIS NEUROSCIENCES CLINIC
Practice Address - Street 2:3160 FOLSOM BLVD, SUITE 2100
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816
Practice Address - Country:US
Practice Address - Phone:916-734-3588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-16
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3601103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist