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General NPI Number Information
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NPI Number | 1881968832
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Entity Type | Individual
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Provider Name | BRANDIS L RUISE BCBA
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Gender | Female
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Dates
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Enumeration Date | 03/07/2012
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Last Update Date | 10/14/2021
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Provider Practice Location Address
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Address Line | 3168 PEPPERTREE DR
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City | MIDDLEBURG
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State | FL
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Zip | 32068-8200
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Country | US
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Telephone | 352-359-4092
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Fax |
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Provider Business Mailing Address
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Address Line | 3168 PEPPERTREE DR
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City | MIDDLEBURG
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State | FL
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Zip | 32068-8200
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Country | US
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Telephone | 352-359-4092
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 0810007282
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-12-10359
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 0133000643
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | LBA066
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License Number State | MD
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Taxonomy #5
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810007282
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License Number State | VA
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