MEDICARE: DR. GAIL CASSANDRA BROTHERS PH.D.

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
1	103TC0700X	Clinical Psychologist	25595	TX
2	103TC2200X	Clinical Child & Adolescent Psychologist	25595	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780761130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GAIL CASSANDRA BROTHERS PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 101011
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76185-1011
Country	:	US
Telephone Number	:	817-689-4744
Fax Number	:	817-207-0704

Provider Business Practice Location Address
First Line	:	6421 CAMP BOWIE BLVD
Second Line	:	SUITE 306
City	:	FORT WORTH
State	:	TX
Zip	:	76116-5401
Country	:	US
Telephone Number	:	817-689-4744
Fax Number	:	817-207-0704

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	01/13/2016

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