Provider Demographics
NPI:1174729743
Name:BRANDYBERRY, PAYTON (MS, LMHC)
Entity type:Individual
Prefix:MS
First Name:PAYTON
Middle Name:
Last Name:BRANDYBERRY
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 CROWN ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-1454
Mailing Address - Country:US
Mailing Address - Phone:802-658-9464
Mailing Address - Fax:
Practice Address - Street 1:210 WINTER ST STE 105
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02188-3338
Practice Address - Country:US
Practice Address - Phone:802-658-9464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA475142101YS0200X
MA6916101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6916OtherDIVISION OF PROFESSIONAL LICENSURE - ALLIED MENTAL HEALTH - L.M.H.C. LIC. NUMBER