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NPI Code Detail

MEDICARE: JA'ME ANN BRANDISH M.A

MEDICARE: JA'ME ANN BRANDISH M.A
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist1067WV

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1Q43388COTHERWVMEDICARE PTAN

General Provider Information

NPI Number : 1285070714
Entity Type Code : Individual
Provider Name (Legal Business Name) : JA'ME ANN BRANDISH M.A
Provider Business Mailing Address
First Line : PO BOX 217
Second Line :
City : ROCK CAVE
State : WV
Zip : 26234-0217
Country : US
Telephone Number : 304-924-6262
Fax Number : 304-924-5460
Provider Business Practice Location Address
First Line : 78 QUEENS ALLEY RD
Second Line :
City : ROCK CAVE
State : WV
Zip : 26234-5890
Country : US
Telephone Number : 304-924-6262
Fax Number : 304-924-5460
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2013
Last Update Date : 08/10/2016

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Directions to “ JA'ME ANN BRANDISH M.A” Practice Location

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