Healthcare Provider Details

I. General information

NPI: 1053620062
Provider Name (Legal Business Name): RACHEL BRANDENBURG PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2010
Last Update Date: 09/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

773 WALKER RD
DOVER DE
19904-2753
US

IV. Provider business mailing address

27 BROWNING CIR
MIDDLETOWN DE
19709-1662
US

V. Phone/Fax

Practice location:
  • Phone: 302-674-2199
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberB1-0000841
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: