Healthcare Provider Details

I. General information

NPI: 1477282614
Provider Name (Legal Business Name): BRANDON DAILEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2022
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 CHESTNUT ST STE 200
PROVIDENCE RI
02903-4604
US

IV. Provider business mailing address

171 CHESTNUT ST STE 200
PROVIDENCE RI
02903-4604
US

V. Phone/Fax

Practice location:
  • Phone: 401-680-0616
  • Fax:
Mailing address:
  • Phone: 401-680-0616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA00557
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLABA10002295
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: