Healthcare Provider Details

I. General information

NPI: 1114150687
Provider Name (Legal Business Name): BRANDON MATTHEW ROBBINS PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2009
Last Update Date: 08/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 W KILGORE AVE
MUNCIE IN
47304-4810
US

IV. Provider business mailing address

3700 W KILGORE AVE
MUNCIE IN
47304-4810
US

V. Phone/Fax

Practice location:
  • Phone: 765-289-5437
  • Fax: 765-741-5265
Mailing address:
  • Phone: 765-289-5437
  • Fax: 765-741-5265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20042346A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: