Provider Demographics
NPI:1730052887
Name:RODDY-HUMPHREY, BRANDI N
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:N
Last Name:RODDY-HUMPHREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 N 11TH ST
Mailing Address - Street 2:
Mailing Address - City:BELEN
Mailing Address - State:NM
Mailing Address - Zip Code:87002-2906
Mailing Address - Country:US
Mailing Address - Phone:505-378-2161
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:708 N 11TH ST
Practice Address - Street 2:
Practice Address - City:BELEN
Practice Address - State:NM
Practice Address - Zip Code:87002-2906
Practice Address - Country:US
Practice Address - Phone:505-378-2161
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM505239326106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician