Provider Demographics
NPI:1366691545
Name:CRAIG, BRANDY LEE (PSYD)
Entity type:Individual
Prefix:DR
First Name:BRANDY
Middle Name:LEE
Last Name:CRAIG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 PINE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:CT
Mailing Address - Zip Code:06237-1521
Mailing Address - Country:US
Mailing Address - Phone:401-692-9396
Mailing Address - Fax:
Practice Address - Street 1:191 PINE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:CT
Practice Address - Zip Code:06237-1521
Practice Address - Country:US
Practice Address - Phone:401-692-9396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-12
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003381103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical