Provider Demographics
NPI:1982292942
Name:PICARDAL, BRANDI MICHELLE
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:MICHELLE
Last Name:PICARDAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:MICHELLE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:94-1415 WELINA LOOP APT 8B
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-4192
Mailing Address - Country:US
Mailing Address - Phone:808-741-2283
Mailing Address - Fax:
Practice Address - Street 1:94-1415 WELINA LOOP APT 8B
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-4192
Practice Address - Country:US
Practice Address - Phone:808-741-2283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORBT-20-132561106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician