Provider Demographics
NPI:1649599739
Name:DALE, BRANDY M (CPRS, ST-C, STNA)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:M
Last Name:DALE
Suffix:
Gender:F
Credentials:CPRS, ST-C, STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8044 MONTGOMERY RD STE 120
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-2919
Mailing Address - Country:US
Mailing Address - Phone:513-607-5128
Mailing Address - Fax:
Practice Address - Street 1:573 MAJESTIC DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-8925
Practice Address - Country:US
Practice Address - Phone:513-279-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-28
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH106S00000X, 374700000X, 3747P1801X, 374U00000X, 171M00000X
OH0001415175T00000X
OH400865580209376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No175T00000XOther Service ProvidersPeer Specialist
No374700000XNursing Service Related ProvidersTechnician
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000Medicaid